Living in Nigeria isn’t always easy. Some days it just feels like too much. To many people, too much pollution, too much noise, too much traffic, too much hassle. I am ready for a vacation, some time out of Africa with feelings of a more “normal life”. It has been a year since we have left the continent of Africa. We leave for 6 weeks of vacation later this week. But as I sit here today I have tears in my eyes over the truly unique experience my family has been blessed with. For an example of the unique mundane that saturates our every day life I would like to share some highlights from just the last 24 hours. There is nothing particularly unusual just life as it is.
I had spent the day volunteering at the clinic. Nothing exceptional happened but I did get to assist with quite a large number of prenatal appointments and I got a good laugh while I was helping to teach the antenatal lecture. I demonstrated how truly terrible most Americans are at squatting and don’t even get them started on squatting while pregnant. Most clinic days I come home jazzed with experiences or full of ideas for lectures or classes. This wasn’t one of those days. I was also feeling very frustrated by the almost 2 hours each way I spent in traffic to get there. My boys got to go to a birthday party and drive go carts. Oliver thanked our kind friends by vomiting in their car on the way home. Dannica went with friends to volunteer at the orphanage and she spent her morning holding babies and chasing toddlers.I’m so glad she gets to have this experience. I am not going to the orphanage any more as my time and energy is best spent at the clinic but I am glad that Dannica is sometimes able to go. On our very long ride home I got to listen to Dannica and her friend sing Hamilton and explain the relevance to our Nigerian driver and Mopol (Nigerian police officer that accompanies me when I go to the clinic). It is hard to describe but it was just such a surreal every day moment.
When we arrived home as the sun was setting. We had arranged with an artist friend of ours to come to our house with some of his work, so we could select some gifts to take back home. He often has work for sale at the American club, and he even taught a batik class to me and several of my friends. He had been fasting for Ramadan and asked us for water to break his fast. We offered him some food as well, and Ben and I made him some more of what we had just had for dinner. Huevos Rancheros with green chili. It was very moving for some reason to be able to offer him some hospitality as he honored his religion, and to share with him some of our food from back home while he spoke of breaking his fast and his culture. Eid Mubarak (blessed Eid) indeed!
The next morning I found myself on the road again to the clinic. The streets were almost empty of cars because it was Eid al fitr, a Muslim holiday and thus national holiday. The streets were not empty however. They were filled with people dressed to the nines. All wearing different clothes from their particular part of Nigeria. So happy. So joyful. Christians were celebrating with their Muslim neighbors in peace.I know this isn’t the case in all of Nigeria but it makes me happy to see it around me. It is a start.
I went back to the clinic that next morning for a planned induction. Following suit with the rest of the world, most babies born at the clinic come at night when I am not able to attend so a planned induction worked well for my timing. This sweet mother had delivered all 3 of her previous babies at the clinic. The first was born still so for the next two, as with this current pregnancy, she had opted to induce at 38 weeks. They induce very gently here sometimes taking 24 hours to delivery. It is actually really nice to observe. Great for the mothers but sad for me because I miss so many births. At clinic I always feel a little bit awkward. I tend to walk around trying to find ways to help or asking questions. Even if I tell the nurses to give me jobs most of them don’t so I just stick my nose in and help whether they ask for it or not. It was just a regular medical clinic day, not anetnatal day so I observed the doctor as he treated different cases. I was able to share with a couple of the nurses my experience with working with Autistic children when trying to get a 6 year old, undiagnosed but no doubt in my mind Autistic boy, to take a nebulizer treatment for his newly acquired asthma. The mother had tears in her eyes as I explained to the nurses that the mother wasn’t “babying him” but rather his brain worked differently and it required a different approach to get compliance. Physically restraining the boy was just making things worse. With a little discussion we were able to help the boy finish his treatment. The nurses had attended a conference on autism within the last few years that was taught by international specialists and lectures. They had a clear understanding of autism but because of the low diagnosis rate and even fewer resources for those that are diagnosed they had never really seen anything in action. They were able to put together in their mind the things they had been taught with what they were currently observing. I was able to help with that. Malaria, malaria, more more malaria. Oh malaria how I despise you. A deeply cut finger from a knife fight. Severe mystery allergic reaction. Lots of interesting medical cases then a friend showed up.
A man I know who is an expat had a possible HIV exposure after he assisted a prostitute that had been stabbed, raped and beaten. The poor girl, maybe 15 years old, was thrown from a moving vehicle and my friend took her to the hospital getting drenched in the girls blood. Although the chance of HIV transmission was low he was very concerned. Getting tested through his employer or a large private hospital could have caused potential problems. He came to the clinic to meet with the doctor and for testing. Of course it was negative but he was touched with how wonderful everyone was at the clinic. I cried with him when he got his results. He has struggled ever since the event occurred a month ago with whether he did the right thing taking the injured woman to the hospital. His employer would be upset if they knew he had gotten involved with local issues and possible security concern but my friend just couldn’t leave her there. We cried that his results were negative, we cried that we knew he did the right thing, and we cried for the girl who did survive.
It was getting close to the time when I was going to have to leave and the mother hadn’t delivered yet. The nurse assured me she would deliver before I had to leave. She had delivered the womans last two babies. Sure enough baby was born. It was a beautiful labor. I have been working with the midwives and nurses in trainings to offer more informed consent during treatment. There has been great improvement in this as the mothers have told me in clinic that they like the nurses teaching and explaining things to them. I have been trying to ease the midwives fears to allow women more freedom of movement during labor. Previously once a woman was in active labor, 5cm +dilated, they were confined to bed. The clinic is too busy and there isn’t someone to stay with them in case they fell or passed out during labor. Many women here are anemic so dizziness is a constant concern. After showing the midwife that the mother wasn’t anemic the mother was able to stand and walk during much of her labor. She was also allowed to empty her bladder on her own rather than using a catheter. I made the mother promise that the second she started feeling like she needed to push she would get right back in bed. The midwives would never forgive me if the baby was born sitting on the toilet. As I was also not trying to run a busy clinic I got to settle into my favorite part of the midwife role, supporting the mother.
The mother did great but the midwife did even better. These midwives are such loving women who work long hours to provide care to their community. I am in awe of them. In awe of how much they are willing to learn and how they want to do what is best. I am saying this to show that I have worked on some improvements in their skills but they already had a great track record. They could just do even better. At our last lecture I shared research regarding not needing to aggressively suction each baby after delivery, what was was currently happening at the clinic. Nucal cords were being clamped and cut immediately causing potential issues for a baby if not born quickly afterwards. Episitomies were being given if they thought there was any chance he mother would tear which was unfortunately much too often. I taught them the benefits of listening to fetal heart tones before during and following a contraction to better assess the health of the baby. I taught them the benefits of delayed cord clamping and showed how much easier a resuscitation was if the baby was still getting oxygen through the umbilical cord. I taught them how to do a complete placental exam so that they would not have to manually with a gloved hand sweep out the inside of every womans uterus right after birth in order to check for retained placenta. I shared with them how perfect mothers chest was to place baby on and keep him warm right after delivery and it helped with bonding rather than baby right to the warmer and the mom not seeing the baby for a couple of hours after delivery. As you can see these women had knowledge of many of the life saving procedures we have for helping more mothers and babies survive childbirth, however they were being used too often, too aggressively, and sometimes causing additional problems.
After teaching a crash course like this in 4 hours you wonder how much of a difference it will really make. In the previous births I observed all of these procedures being done routinely for almost every delivery. I was hoping for a positive change in even one area. The midwife did so amazing!! The mother started pushing, she didn’t tear and the midwife didn’t cut, baby had a nuchal cord which the midwife calmly slipped over the babys head, the baby went right on moms abdomen where it was dried and covered with a towel. No aggressive suctioning done, no suctioning at all as baby was screaming, pink and vigorous. The cord was allowed to pulse for 2 minutes while antihemorrhagic medication was administered, then the cord was clamped cut and the placenta delivered using active management(a technique that greatly reduces post partum hemmorhage for at risk women). The placenta was examined and it was complete, meaning no manual exploration of the uterus.The baby stayed on mom the whole time. After about 15 minutes the baby went to the warmer for his exam, cleaning etc. You guys, I almost cried. It was so beautifully done. I didn’t have to give any coaching to the midwife she just took the new information taught in the lecture and implemented it beautifully. If only all people were so eager to learn and do better. The mother was so happy.
I came home and my kids got to go to a movie hosted by the wonderful Marines. They work so hard to help keep us safe and they have fundraisers like this to raise money for their activities and needs. Ben and I had a lovely dinner eating Lebanese mixed grill while looking over the lagoon.
There was some cleaning, bed time routines, preparing of meals and lots of mundane in this 24 hours but how many people can say they get to have such unique experiences in their every day mundane. Not many. For everything that is difficult much more often I feel very very blessed with the life that I am living every day.