Babycatcher

Thursday I headed back to the labor ward at Maternal and Child Health Hospital (MCHH). A week had passed since my return from Accra but I still felt like hiding in our room from the possibility of more disappointments, but after a week I forced myself out. I forced myself to walk to the bus stop, to board, and then to make my way through the noisy crowded market. I reminded myself that the best moments so far in this city have all happened at MCHH. I reminded myself that there I can be useful - which is what I miss most here - and so I kept walking until I made it through the doors of the maternity ward.

Everyone greeted me warmly. I put on my scrubs and found the midwife on duty delivering a woman with twins. Three other women labored in the adjoining room. I started my rounds with Twumwaa, a 22 year old laboring with her first baby. At first Twumwaa’s face tensed with fear and pain during her contractions but with my hand on her back and a few encouraging words she relaxed visibly. From her I moved to Kate. This was also Kate's first baby and every now and then her body shook and she snapped her fingers as a contraction rolled through her. I stayed with her a while, my fingers lightly on her belly. She was still in early labor and her baby was doing well. Finally there was Rita who was not in labor but had come because her water had broken the day before and she needed antibiotics. As I waited for the night midwife to give me her report I stayed with them, chatting with Twumwaa and rubbing backs. Twumwaa showed me a few wedding pictures on her phone. She told me about her husband and her family. Her sister Porsha had delivered a boy two weeks previously at MCHH and was in the next room waiting for a sickling test. Twumwaa’s mother also came in and out, bringing porridge and water, both happy and anxious.

After a while the midwife told me that none of the women had been examined. By that point Kate’s contractions had picked up and I heard the baby’s heart rate slow after each one (either a sign of distress or approaching delivery). Unfortunately when I examined her she was only one centimeter dilated so we transferred her to KATH, the large teaching hospital up the hill. When I returned to MCHH I sat with Twumwaa, chatted, listened to her baby and periodically listened to Rita’s baby. I would have loved to stay and attend Twuwaa’s birth but I did not like the idea of making my way through Kejetia (the sprawling open market) after dark. So around 3:30 I said goodbye.

The next morning I found Twumwaa smiling ear to ear next to a little baby boy. When I asked her what time she delivered she said, “You told me I would deliver at 6 and I delivered at 6.” Her mother had been with her (or rather outside the delivery room when she delivered) and now greeted me warmly with a big smile and a huge bag of papayas and green plantains.

In the labor room I found Rita now visibly uncomfortable with contractions. I examined her. Her baby was breech, she had no fever but the baby’s heart was racing, and her cervix was only dilated five centimeters. This was Rita’s third delivery. I could not fully grasp the details but Rita said her second delivery was difficult and that the baby had died on his first day of life. Having witnessed too many tragic endings to similar stories I prepped Rita, took her phone number and transferred her to KATH. Each time I came in and out of the postpartum room Twumwaa’s family greeted me with warm smiles. I was not even present for the delivery but their joy at having a healthy newborn overflowed on to my shoulders. When they left that morning, Twumwaa’s mother said they wanted me to come to their home soon and she reminded me to put the papayas and plantains where I would not forget them.

A few hours later after transferring a third patient to KATH, I found Kate post c-section lying besides a sweet baby girl but found Rita still lying on the bed where we had left her. When I put the fetoscope to her belly I heard the same racing heart beat but now with the ominous addition of decelerations after each contractions. I found the nurse on duty and asked her what was happening. She said the doctors would be back soon and with smiles I begged her to take special care of Rita. I kept Rita in thoughts and prayers all day then steeling myself for the worst called her that night. Her voice was joyful, she said that she had delivered vaginally, and that the baby was now okay. Filled with gratitude and relief Clement and I sat down to our meal of black-eyed peas and plantains.

People are getting ready for the elections this Sunday, 7 December 2008. At 4am someone blew a horn for a good 20 minutes while walking up and down the street. Then at 6am someone within our building turned their stereo up to share their gospel music with the world at full volume. It’s Saturday. On Wednesday I was in Accra and what should have been a maximum of an hour long minibus ride took three hours due to a huge political rally. For weeks now large chartered buses have been cruising the city, packed with people dressed in their party’s colors, leaning out widows, shouting, cheering, waving, blowing horns. This is the third democratic election since Rawlings, the military president, left power in 2001. Rawlings took power in 1982 and his military rule lasted until 1991. That year a new constitution was approved, multi-party elections were held and Rawlings was elected President. He held the presidency for two consecutive terms then in 2000, John Atta Mills (Rawlings’ Vice President) ran against John Kufuor. John Kufour won the elections and his rise to presidency marked the first peaceful transfer of power. In 2004 President Kufour won the re-election but now at the completion of his second term he must step down. Kufour’s party, the NPP has nominated Nana Akufo-Adda while, for the third consecutive election, NDC has nominated John Atta Mills. Ghanaians who remember the Rawlings era as the too recent past - with its human rights abuses, the disappearances, the stripping and beating of women in the streets - say never again. But, Atta Mills has been building up his constituency among the youth whose memories do not include such difficult times who argue that he became involved with Rawlings after the infamous era of human rights abuses so he should not be blamed for those incidents. Everyone is concerned about peace.

I am not worried about violence in this area. I feel no hostile energy in the city, in fact pleas for peace are ubiquitous. Coverage of the recent US elections were followed by local commentary on take home lessons for Ghana and the peaceful transfer of power. Last Sunday mass concluded with a prayer for peaceful elections and the church bulletin included a two page write up on the purpose of democratic elections. Most people I have spoken with say Ghanaians have experienced too much to resort to violence. I am not worried, but my thoughts do occasionally revisit a scene from a video presentation at a local museum. In the opening scene the camera panned a large crowd of men surrounding the Ashanti king all chanting and hoisting guns over their heads, while in a monotone voice the narrator said, “The Ashanti are a peace-loving people. They are always ready to defend themselves” . . . an interesting twist of logic.

Malawi will also hold elections next year. Since their dictator or “President for life” Kamuzu Banda, who ruled for 30 years, they have had three elections. Muluzi ruled for ten years (two terms) enriching himself greatly while infrastructure deteriorated and the people starved. Then in 2004 president Bingu waMutarika was elected. President Bingu lacks Muluzi’s charisma but many praise his efforts to cut down on corruption the physical development of Lilongwe has been significant over the past 4 years. President Bingu will run again but Muluzi is trying to elbow his way back into power (despite the fact that the Constitution limits any individual to two terms). Another likely contender is John Tembo, Banda‘s former Vice President. It seems in many countries African politicians never step down they just reinvent themselves. I have heard many Africans from different countries complain that political stagnation at the top is one of the greatest factors negatively affecting development. Clement says simply, “It is time to put this power hunger to rest.”

I just returned from taking the nursing exam in Accra. Only a few questions covered the material I studied but still, it was not a difficult exam, and for once in my life I did not feel compelled to score well. I am quite sure I passed and that will be enough. It was however, a frustrating experience. I learned at the exam that if I want to be registered as a midwife in Ghana, after the results are out for this exam and after I complete three months of full-time unpaid “orientation” at a teaching hospital, I must submit another application, pay another fee take another exam and do another three months of orientation in order to be registered as a midwife. Since I will be in the US in June - working for money so we can eat - I won’t be able to take the midwifery exam until next December, which means I will not be registered as a midwife here until mid-2010!! This kind of ridiculous bureaucracy is what bring me to the point of wanting to pack my bags. It is not the struggles of daily life or even the tragic and stressful experiences in the hospital, but the nonsense roadblocks set up to prevent people from actually being useful in the areas where they are most needed.

We were 20 foreign-trained nurses taking the exams to become registered in Ghana. Most of those in the room were Ghanaians who had trained in the UK or US and were returning home for a period to work and help their country. During the break between the exams, nurses traded story after story of how the Nurses and Midwives Council made every step of the process difficult. Several nurses had started the application process two years previously. While in Accra I also heard stories from another nurse returning to the public sector after leaving the field years previously to raise a family. She was required to complete six months unpaid orientation in the public sector, in a town two-hours from where she lives (she rented house and paid for transportation without an income). Since completing that phase she has spent the last three months waiting for an interview so she can begin work. Another nurse who was trying simply to transfer back from the private sector to the public sector was also made to work a six months unpaid orientation. Somehow a punitive mentality seems to be obscuring the vision of what is required to create a better health system. Ghana, like most of Africa, suffers from a severe nursing shortage. While it is necessary to monitor the caliber of nurses coming into the system it should be possible to streamline the process for the benefit of nurses and more importantly for the benefit of those receiving health care at public facilities.

When I left Malawi I left the seedling projects I had been working on in the hands of my good friend Beatrice Namaleu, a nurse with 28 years experience in maternal and child health care. With minimal funds and no additional support other than sporadic phone calls and emails she has been visiting and supporting 19 infants, overseeing the feeding program which feeds about 50 children three times a week, and paying school fees for 10 adolescents. We have no office and no support staff. We have a small local Board of Directors, Beatrice, and one hand-me-down computer donated by a friend. The nurses in the newborn nursery at Bottom keep a log of the babies whose mother die during childbirth and others who need follow-up visits at home. These nurses teach the guardians how to prepare formula for the baby and contact Beatrice so that she can arrange continuing home visits. Since Bottom is the referral maternity hospital for the Central Region of Malawi at times women come from great distances to deliver there. Without a vehicle Beatrice makes her way to the babies via minibus (privately owned minivans used for public transportation into which 15 passengers are squeezed) and bicycle taxies. While I was in Malawi, I accompanied Beatrice on her visits using these types of transportation to experience the work as she does day to day.

Our first visit was to Chikumbutso, one of the first babies I started following. Her mother died after giving birth at Bottom in February 2006. We boarded a minibus in town waited for it to fill, rode about 40minutes out to the town nearest Chiku’s village then hired two bicycle taxies to take us the remaining 15 kilometers. At certain trading areas off the main cross country roads and in small towns where minibuses are few, men with bicycle taxies gather in large groups waiting for passengers. They earn their living carrying people and cargo (e.g. 100kgs of maize or fertilizer, firewood, charcoal, goats, pigs, chickens, etc) around on their cheap single gear bicycles made in China. Those who generally transport people add padding to transform the bicycle rack into a fairly comfortable passenger seat.

I had traveled the road to Chiku’s village many times previously but always by car. It was a new and pleasant experience to ride through the farmland and neighboring villages on the back of a bicycle. As we neared the village I heard my name shouted by children before the bikes came to a stop. Chiku’s brother and cousins, her aunts, and grandfather came to meet us. Chiku, always suspicious of strangers looked at me with the same sour expression she had been giving me since she was an infant. I kept my hands off but laughed with joy. Seeing her now on the cusp of her third birthday and hearing her talk quietly to her brother filled my heart. She climbed onto her grandfather’s lap keeping us under observation as we chatted with the adults. As we mounted the bicycles again Chiku’s grandfather told Mrs. Namaleu to tell Clement to take good care of me and expressed his gratitude saying that the family would have never managed to keep her alive without our support.

From Chiku’s village we boarded the bicycles again and headed to see David. This was my first time meeting David but Mrs. Namaleu had been visiting him for several months. David lives with his grandmother. He is 11 months old. His mother was diagnosed with post-partum psychosis and shortly after his birth she was institutionalized in a hospital five hours South of the family‘s home. Within a few weeks the mental hospital contacted the family to report her sudden death. David’s grandmother said her daughter was not sick physically when she was taken away so the family was surprised by her unexplained death but when the body arrived they saw that she was covered in bruises.

At this point David is small for his age and his grandmother requires a significant amount of assistance in providing his care. When we arrived we found the grandmother home alone she led us inside her mud brick home with its dilapidated thatch roof and spread a tattered grass mass for us on the floor. She then collected David from a relative and told us he had just eaten but from his voracious sucking on his fist and inconsolable tears we decided that if he had eaten he was not full. Beatrice set to work, starting a fire in the center of three stones in the single room, preparing milk and then teaching the family how to prepare nutritious porridge for David with readily available local food: maize, soy, peanuts, and vegetables. As we left we decided that Mrs. Namaleu will increase her visits to monitor David, observe his care, and provide assistance as best she can. By the time we reached the small town in-between Chiku and David’s villages evening was setting in so we boarded a minibus headed back to town and then home.

I spent the first weekend with Clement’s dad, brother, best friend Fatsani, and grandmother in Mangochi. His grandmother made tobwa (a drink made from maize and millet), they prepared nkwani (pumpkin leaves - my favorite Malawian vegetable) and Clement’s dad paid too much money to buy me an illegal fish head (the lake is closed from November to January to allow fish to spawn but people continue to fish illegally) which I guiltily shared with William (Clement‘s 19 year-old brother). William accompanied me to the village to make the rounds to all the aunts and uncles but we found most of the adults missing. November marks the beginning of the rains and the time for planting. Malawian’s staple crop is maize which is not indigenous, it requires fertilizer to grow well. Most Malawians grow their own maize, even those living in town, and every year the government subsidizes fertilizer by providing coupons for distribution to the poorest in each village. Fertilizer is relatively inexpensive with a coupon but without a coupon villagers must often sell their livestock in order to raise enough money to buy a few bags. This year the government is providing significantly fewer coupons. I am not sure about the politics involved but people are very worried about how this will impact maize production. While we waited for the adults to return from lines in a nearby village, William and I hung out with children, walked to the lake and shared stories. Everything was over too quickly and moments after I arrived I was back at the bus station saying goodbye to Clement’s dad.

The next week was filled with more visits and a spontaneous trip to the border of Mozambique. A set of triplets were born at Bottom in August and a few weeks later the nurses in the nursery contacted Mrs. Namaleu to follow them up in their home. The mother was alive and well but the babies did not seem to be growing well. Mrs. Namaleu began visiting them in a village outside Mitundu (involving another 40 minibus ride and then a 30 minute bike ride). Thursday morning, Mrs. Namaleu phoned the village chief (the only person with a cell phone living near the triplets) to ask whether the woman and her triplets were home. He told us to come and that we would find them. When we arrived in the village we were greeted by the maternal grandmother of the babies who informed us that her daughter had taken the babies to Mozambique the previous week to follow her husband. I never fully understood why the husband left - one story was that he went to find work another was that he married a second wife - whatever the reason his wife decided despite the pleading of her family to load her belongings and three infants on a bicycle and follow him.

Mozambique shares three quarters of Malawi’s borders; on a map Mozambique appears to be in the process of swallowing Malawi. There are sections of the main road running South from Lilongwe where just meters to one side of the road is actually Mozambique. So, when the grandmother told us that the village in Mozambique where her daughter was living was not far, Mrs. Namaleu and I believed her. She explained the route to the bicyclists and they agreed saying, “We can make it there and back in good time.” It was 10am. As we just started off the man whose was carrying me pointed to some distant blue mountains, said the village was on the other side and that it would take us about four hours to get there. Malawians are notorious for their underestimation of time and distance so hearing that was enough for me to call the whole thing off but the moment I started questioning and told Mrs. Namaleu both of the cyclists began insisting that it would take only three hours. Mrs. Namaleu became convinced and I decided to accept the adventure. I tried to send a text message to Ruth telling her that I might not be home until Friday but there was no signal.

I could not show on a map the route we traveled, we did not approach any roads, instead we weaved our way through villages, farmland, and a forest reserve, climbing and descending rolling hills until we finally began to ascend the mountain once blue in the distance. I chatted with Braveson as we traveled amazed by his strength and endurance. We shared bread and stopped in a village to refill my water bottle at a borehole. Adults who caught sight of my face under my wide brimmed hat stopped in their tracks shocked by the sight. Children pointed and screamed with delight. As we ascended the mountain Mrs. Namaleu and I got off the bikes frequently to walk beside them. Mrs. Namaleu and her cyclist often lagged behind and at various points we debated whether we would be able to make it to our destination. Each time we decided to continue. Finally after four hours we arrived at the border which consisted of a small adobe compound with one desk manned by a Mozambican solider. He charged us each 100MK (about US$0.80), to stamp a piece of notebook paper and add his ostentatious signature. The solider spoke Chichewa and Portuguese only, so with my rusty Portuguese I asked him how far we had ahead of us. He and his friends laughed at the idea that we would be able to travel to the village and back in one day. A man on a motorbike came up behind us and said he would carry me to the village and back for a fee. He said it was not very far but when I asked how many minutes on the motorbike and he said one and a half hours I knew our journey had ended there at the border. If I had been able to contact Ruth, and if Mrs. Namaleu could have called her daughters I would have felt comfortable to continue but it was not right to worry them unnecessarily. We debated a while longer about how to get the formula to the family but finally decided that we would have to carry it back. (Mrs Namaleu felt that if we entrusted it to a stranger it was more likely that they would sell it than deliver it.)

I was disappointed about our failed adventure but more worried about the condition of the triplets. I could not imagine how the mother made the journey alone with her babies on the back of a bicycle. I wondered who was helping her care from them in Mozambique. Our return trip was faster - a mere three and a half hours. It was just as beautiful but cooler. Braveson and I lightheartedly agreed on four problems which contributed to our failed quest: (1) the village chief telling us to come; (2) our late start; (3) Braveson’s underestimation of the time; and (4) his colleague’s slow pace. Braveson was particularly keen on problems two and four. Mrs. Namaleu is a bit heavier than I am but when I suggested that this might be why his colleague was constantly lagging behind, Braveson refused to accept this reasoning. He said that at times they carry 100kgs of maize and even a 70kg person is much easier to carry than 100kgs of maize. In my opinion, cycling for 7 and 1/2 hours even with only a 50kg load is an amazing feat.

By the time we reached Mitundu the sun had set and the last minibus heading to Lilongwe had already departed. Luckily we were able to hitch a ride in the back of a covered pick-up. Once in town we boarded a minibus and then Ruth collected me from a gas station near her home. We did not accomplish what we had set out to do but the family would hear about our adventure and meet us at Bottom the following week. We would find the triplets hungry but alive and well. That night my sense disappointment was eclipsed by a greater feeling of being alive, the newly laid memories of a beautiful day, the smell of the air in my clothes, and pleasure of a shower, and the joy of lying down to rest.

The following day was my 33^rd birthday. I treated myself to a haircut and pedicure, had tea with a friend, received a birthday call from Clement and then from my parents. I had lunch with the Namaleus which evolved into a spontaneous dance party, then had dinner with Lisa, met 9-month old George and chatted until midnight. I am somewhere I never imagined I would be but this journey with all its unexpected twists has also brought so much unanticipated joy. This is what I must remind myself of during the moments when I crave something else or when I simply crave a life path with fewer curves and better visibility of the road ahead.

The following weekend I visited Clement’s mother and stepfather in their village in Salima. William had spent the week with them. I was happy to see him again and grateful for his help with communication. Village life is full of physical labor but as a visitor I always find my time in the village to be a peaceful retreat. We spent the afternoon sitting on a mat greeting neighbors. Now and then I noticed neighbors bringing plates of food to the house, flour, nsima, mangoes. I have seen this each time I have visited and I asked William whether they do this because his step-dad is the chief or because he has visitors. William said that the people there share what they have with each other and it is something he has not seen in other villages.

Clement’s mom prepared a chicken and offered me more than I could eat. Then William and I visited the farm with James, his step-dad, to see the dry earth tilled in neat expectant rows. I took a bucket bath in their newly built adobe shower then as the sun set we ate small sweet mangoes until my skin felt tight over my belly. Inside the house, the temperature was stifling but outside was cool and fresh. William said he had been trying to convince them to sleep outside all week and so when I mentioned sleeping outside he made sure his mom heard. She prepared two grass mats on the sandy ground, covered each with a few layers of blankets and cloths and then we all laid down under the stars. The night was crisp and peaceful, the silence broken occasionally by sounds in the distance of people talking or laughing, or dogs barking. Sometime around 1am a few rain drops began to fall and though I would have happily continued to sleep under the dripping sky, we moved inside. The rain never fell that night.

Early the next morning Clement’s mom woke to fetch water. Apparently the village borehole has been broken for three months so now she must walk to a nearby stream to collect water. I jumped up and offered to help but everyone laughed and told me to go back to sleep. When she returned the skies opened and we sat inside drinking tea watching the downpour. They told me that every time I come, I bring the rain.

A few hours later William and I left. I wanted to see the lake near the village so William directed my driving. He had biked to the lake during the week with Felix (their young half-brother). Felix told him initially that the lake was nearby and then from his seat on the back of Williams bike - each time William felt discouraged or tired - Felix would say that they were almost there. The lake was 18 kilometers from the village. We laughed over our similar experiences of “almost there.” William is quiet and sweet and has a good sense of humor. It was lovely to spend time with him, trade a few stories and laughs. When we returned to Lilongwe, I took him to the bus station and hugged goodbye.

The rest of my time in Malawi, flew by. The days were filled with visits and the evenings with friends. Every night I slept soundly and every morning I was surprised by the hasty arrival of sunshine. Every day carried joy and the familiar enigmatic feeling of overwhelming love. The feeling would come while looking at Chikumbutso and her little sour face, or sitting with Nayopa family drinking Sobo and laughing, or holding Catherine (Ireen’s baby girl who was born around our wedding time last year) and kissing the top of her sweet smelling head, or riding through the country on the back of a bicycle, or watching Pamela gently and lovingly tend to her three surviving quadruplets, twins and three other children. In those moments I felt I would do anything to sustain the feeling of such a perfect inebriation. I think when you see someone struggling through life but living with incredibly love the natural response is an urge to drop everything and become a part of that force.

The only difficult part of being in Malawi was being separated from Clement and not being able to talk apart from a few minutes every couple of days. Still, my departure day arrived too soon. I packed my suitcase like an African - a few clothes, toiletries, etc. then ofa (maize flour), millet flour, kapenta (small dried fish from Lake Malawi), Nali (Malawian hot sauce), Malawi tea, chocolate and Belgian chocolate, and a bottle of Champaign (the chocolate and Champaign were gifts from a Belgian friend just returning from home). Thankfully no one at any of the airports requested to look through my bag.

When leaving Ghana I thought that on my return I would stay in Accra several days until completing my nursing exam but when the plane touched down the first thing I wanted was to get back to Clement. As I stepped outside I could feel my pores opening in the heat and a weight or maybe a familiar sadness settle over me. I found a taxi, boarded a bus to Kumasi, and after five bumpy hours I stepped down into light of Clement’s handsome smile. I left so much behind in Malawi but here with this man there is also comfort, love, and hope.