"UGH! I wish I wouldn't have worn this skirt!" I pulled the bottom of it up to my mid thigh, a part of the body that is highly inappropriate to show in the village (like running through the streets topless in the US). But the pastor said GO FAST, and there was something in his voice that meant it. It was dark, in a deep-in-the-forest-stars-are-out kind of way and we were running away from the majority of the population, down the hill back towards the clinic. No one would see.
"I wish we would have brought the flashlight..." Simone said, balancing on her tip toes about to jump a puddle.
We were carefully stepping over stones, walking through mushy areas and leaping across deep crevices carved in the clay like dirt by years of stormy runoff. I didn't want to fall, but I didn't want to miss the birth either. When we made it through the most precarious part of town we sprinted.
Somebody yelled out from their compound "Sisters take this!" But by the time we turned around and saw the woman standing in the orange glow from a dangling lantern above her head we were already too far away to care.
The waiting room of the maternity ward is airy and cool, mostly because half of it is screened in, with a panoramic view of the surrounding bush and the cement walls only going waist high. When I got close enough I could see, inside, a small group of women in white, each bouncing up and down with the seriousness of their prayers. When Ghanaians talk to God, they mostly do it out loud, and if God couldn't hear these then I would have to doubt he could hear at all.
I pushed the screen door open and quickly moved past the ladies, through the hallway, down to the labor ward. I heard the sound of a baby, not a vibrant expressive cry, but a barely audible cackle, and when I turned the corner I saw the child wadded up in a soft blanket on the table next to the scale. The mother was still on top of the delivery table and Efreeyeh was looking the most exhausted, leaned back in a chair, legs spread apart and head drooping to the side. She didn't even say hello. If I hadn't had known I would have guessed she was the one who had just had the child.
I went straight to the baby. I heard Simone come in and down the hall. "He's floppy." I said. "And really pale."
"Is he okay?" she asked.
"I don't really know. But we need to wrap him more." His legs were dangling out the bottom of the blanket, and it was a thin piece of cloth, too thin to keep him warm. When I picked him up I felt the forceps still attached to his umbilical cord, and knew it must have been a difficult birth. When the baby isn't washed, and there is no time to remove the forceps and clip the blue plastic umbilical cord clamper in place, I know there will be a story to come.
"Was it just you?" I said facing the wall, hoping Efreeyeh would respond.
"Vic (the head nurse) is in the home. She has gone to get some suturing material. The woman has a tear."
I wrapped the baby up with a clean flannel long sleeved tshirt of mine. There was nothing else available. "The baby isn't breathing well."
But Efreeyeh already knew this. She was exhausted, as I would find out the next day, because they had been giving mouth to mouth and doing 'a chest rub to get it's heart to pump more'.
But when Vic came back she didn't tell me this. Everything seemed cryptic, and I only felt I had half the code to figure it out. They weren't going to give any verbal clues, they were too weary and focused for this. Vic and Efreeyeh moved around the delivery room like zombies. It wasn't anything personal, but they had a job to take care of and not a lot of time or energy to worry about other consequentials. "Akua unwrap the child. I have to give the injection."
She inserted a very long needle into his chicken-like leg.
"What's that for?"
"For the lungs. To get the breathing to come."
Vic said "Please bring the torch here. I need light to do the suturing." The 60 Wat light bulb was not helping much.
I held the flashlight above her head, shining the light down into the area Vic was sewing. It was the only severe tear I've ever seen, and it wasn't pretty. Vic kept parting the skin to check and see how deep it had gone, and when she was ready she pierced the woman's vagina with the suturing needle.
The woman, made a hissing noise and squeezed her face.
"Won't you give her local anesthetic?" I asked, feeling nauseous.
"After childbirth the pain is not too much. They can't feel what I am doing."
But each time she slid the needle through another patch of bloody torn skin, and pulled the thread up until she had to straighten her arm, the woman's wincing got louder and louder. It was close to unbearable before she decided to numb her.
Now, Vic is not a cruel woman, and she wants the best for her patients. She is, in fact, an incredible nurse, and the heartbeat of the health clinic. When she isn't around, everything feels off, and everyone notices. I trust learning from her, and realized there was a major cultural difference in the concept of pain threshold. I began to feel woozy, and asked Simone to take over holding the light.
"Hold the baby." Efreeyeh said, handing him off. I had a moments insecurity. If I can't watch a suturing, how can I be a midwife? I cooed to the child. Step by step, I told myself.
I walked over to the mother and bent down on my knees, so she could see her child's face. She stared at it, and smiled big and gratefully, and asked if it was a boy or girl.
"Can I tell her?" There are some traditional beliefs they hold in terms of telling the sex of the baby. They don't like to let a woman know before she has delivered her placenta or else, if it is a boy and they do not want a boy, or if it is a girl and they do not want a girl, their uterus will go into shock and keep the placenta. I wasn't sure what they thought about informing before repairing, but Efreeyeh said "you can tell her."
I realized, in my concern for the child, I hadn't even bothered to look. I had assumed it was a he. "What is it?" I asked, and Efreeyeh answered in English. I got to relay the sex to the mother in Twi, that she had a baby girl, and she was well pleased.
She stayed the night, and visitors in white began to stream in. The screen door slammed all night long, with pairs of loving supportive friends and church members coming in and out to visit their sister. I barely slept, kept awake by worried thoughts about the child and frustration over wanting to be more educated than I am. Even if I was to check the baby I wouldn't know much. I wanted to be able to accurately assess her health, to reassure myself and everyone that it would be alright. Throughout the night each time I heard the child make a noise I wondered, is that normal? Simone woke up and asked the same question. "Is the baby okay?"
Early in the morning, close to when the roosters were crowing I went to go check and see how she was. Optimism hit when I saw she was glowing, more pinkish brown than pale, and feeding well. The mother looked content and well loved by all the attention she was receiving.
I went outside to brush my teeth and saw Vic sitting on a bench outside of the Injection Room. I thought it'd be a perfect time to talk, to hear her rundown of what happened the night before. The great thing about Vic is that, when given the appropriate time, she loves to teach. She loves to thoroughly explain all that she knows and make sure you, as a student, understand. When Simone and I went to her house and asked her about the best method of catching a chicken (we have two goals to accomplish before we leave: catch a chicken and eat a fish head), she brought us to the coop and explained the life of a chicken from embryo to full grown. She told us about how to raise chickens, slaughter chickens, educated us on their markings and the specifics of the eggs they produce. She brought us to see her own, manhandling a resting mother hen and plucking one of its day old chicks from right beneath her. "These babies here..." We were chicken experts by the time we left that evening. So I was looking forward to all that she had to say.
But just as I was approaching her, an elderly mother and her daughter, about my age, were also walking up, with a toddler attached in a wrap to the grandmother's back.
"Good Morning." I said to Vic, as the grandmother bent down and the mother untangled the baby from behind.
"Good Morning Akua." And we turned our eyes to the child.
The family didn't waste any time greeting us, one of the most important formalities of the Ghanaian culture. They handed the infant straight to Vic and pleaded for help with the creases in their eyes. The child was malnourished and very sickly. His head was bent backwards, and his eyes were half open, stone like, coal marbles, gazing at nothing. Above his right eyelid a sore had developed, and smeared all over it was some type of herbal remedy. But the most unsettling, and haunting, observation was the continuous gasping that escaped the child's dry lips. I have only heard that gasping once, and it meant death. My throat got tight and my chest tensed up. I didn't dare interrupt to find out what they were saying but I understood enough. The child had been sick for a long time and the mother, instead of coming to the clinic, had opted to go with what she felt more comfortable doing. She went to see an herbalist. Waiting until the last minute, the herbalist told the mother there was nothing else he could do, that the baby needed to go to the clinic. She rushed her child here, in this condition, hoping we could help.
He was resting in Vic's lap, limp, with the stench of the probability of death hanging heavy in the atmosphere. "Go quick and get me the same medicine we gave the baby last night."
I ran into the maternity ward and found a small ampule of liquid (--?---). I brought it back to Vic and she filled a needle full of it, then gathered the last bit of flesh from the baby's thigh, and stuck it directly in. His leg was so little and the needle so long I was expecting to see it come out on the other side.
"He's in a coma." Vic said, "he hasn't felt the needle. Do you see? No reaction. Nnk, Nnk, Nnk." She shook her head. I was looking, we all were looking, at her for signs of optimism. But there were none. In her eyes I saw worry, mixed with anger, and a certain level of retirement. It was a strange combination.
She told the mother in Twi, that her child had a 50/50 chance at survival, that she had waited too long to bring him in, and this is the best we can do. She needs to bring him to the nearest local hospital, which was at least thirty minutes away by taxi, and he needs to go into critical care immediately. The mother couldn't look at her child, and the one time I saw her do it, her chin quivered and she shut her eyes. I felt immense pain.
Throughout the entire conversation, or consultation, the gasping continued. It is the most horrible noise I have ever heard. It didn't sound human.
My head was muddy.
What is death? What is life? How can it just be here one minute and leave the next, and all around everything else seem so normal? Where is this baby right now? His spirit is somewhere, but not inside him. I could see that. It was traveling, working itself out, moving on, or maybe... coming back? The look on his mother's face was the most convincing bind to return.
As for his body, his shell, his other home, it didn't even feel that needle.
I felt far away, very far away. I couldn't connect to any thing. I was looking at the baby, the mom, and Vic, but none of it seemed real. I was watching this. It was a story. Baby's don't die in front of their mothers like this. Mother's don't do this to their babies.
At one point, the mother fell to her knees and with her teeth, destroyed the string and sachet of herbs tied around her child's wrist. It was the medicine she had put all her faith into, that sachet had held her trust, and now, because Vic needed to free his wrist for something I wasn't comprehending, her incisors were gnashing at the very thing that she thought was to bring him health. Her last resort, western medicine, was at this point, what he needed most. Western medicine saves lives. If it wasn't too late already. Why had she waited so long? I didn't want to see him die, his chin lifted upwards, with each inhale there was never an exhale. Like a person drowning. I hated it. Time was passing and we weren't doing anything. Just witnessing.
I turned my back and walked away, back into the maternity ward, back to somewhere i felt safe. i ended up staring at the scale, where newborns are weighed. i exploded in quiet tears. in misery for what was just outside the walls. My shoulders shook with sobs, and i let myself go.
Witnessing death makes one feel small, smaller than I knew I could be. And useless. How could I be so use-less? My feet were dead, unwilling to move back out there now. I couldn't be useless watching, gasp, gasp, gasp, gasp. His thin dry lips. His graham cracker chest, ready to cave or crumble. The mother, the soon to be childless mother. I couldn't go back out so I went to my room where my soft weeping gave me away.
"What's wrong?" Simone sat right up from being completely asleep. Her eyebrows furrowed. "Kaciewhat'swrong?"
"There's a baby dying out there, he looks awful, and he's trying to breath but he can't." I cried through my talking, "and I don''t know what to do."
I collapsed on her bed and she draped her arm around my shoulder. "Oh nooooo."
I cried some more. I drained myself. It was my last morning here and this is what I was going to leave with? This?
"Akua?!?!" An energetic, excited voice chirped from around the corner, from the waiting room.
"Oh God." I wiped my face, pushed some random stray hairs out of my eyes, tried to pretend I was okay, because that is what people do here. They don't cry in public. You have to be stronger than that. Nobody was going to know I was hurting, that I was so sensitive and didn't know how to handle things. I would hold myself together.
"Kiiissssssyy!"
I walked out of the room and saw one of my coworkers, smiling at me. "Eh! Akua! You are leaving us this morning!"
I tried to smile back, to let Seketry know I appreciate his coming, that I would miss him too, but my fake smile gave way to a frown and my frown almost triggered tears. He put his hand on my shoulder. "Oh you are sad. I can see. Akua. The baby will never die."
I wanted to believe him. But it was a lie. Vic telling the mother "50/50" was a lie. We lie about death, because it's so final and there is nothing we can do. We lie until it happens.
While he comforted me a parade of Methodists broke in to the room and began to fill all the empty spaces. Tons of them, streaming down the path from outside, walking radiantly in the sprinkling rain, some holding huge banana tree leaves over their heads to keep their white scarves clean. They were jubilant, bursting, joyful, alive. Living bouquets. They were shaking my hand forcefully patting me on my arms telling me that they have come to "collect me".
Simone heard the voices, all the voices, and came out in her pajamas.
"My sisters" someone announced "we've come to see if you will bless us this morning by singing solos at our morning service?!?"
The idea of singing at all was so far from me right now, as was laughing at their joke. I hoped it was a joke.
They looked at us longingly for an answer but just as I was feeling the pressure the mother who had stayed overnight walked out from the lie-in ward. She was tall, taller than I had expected. I had only seen her on her back, after her delivery. Once everyone in the room had seen her, attention quickly switched to the prime reason for their visit, to shower her in love. Somehow, deep in my spirit, I knew I had been divinely placed. They had come for her, to bless her, but just as the sun shines on us all, whatever she was getting i would too.
A dark, wrinkly old woman closed her eyes and sang out from the depths of her being in a twangy pure voice. In unison, the group followed and sang so soulfully in the first few moments that veins protruded from their foreheads and necks. The men expressed themselves in low, deep, grounding sounds and the women were angelic. Absolutely angelic. The sound was incredible. I looked at Simone. Music like this is too good to be this spontaneous. It felt too good to be true. The voices were weaving through the room, each other, my mind, looping and dancing and wrapping, coming back around again. They were working out my kinks of pain, helping to dissolve my stomach full of despair. I bent my head down to hide that I was crying, again, only this time for a different reason.
The song continued and I was completely lost in them, lost in the awe of being with The Methodists. But they weren't 'The Methodists' anymore to me. They were the church, the way the church is meant to be, a living breathing restoring body. A body that moves and sings and goes to people when the people can't come.
They sang, and sang, and sang. Their love a cold wash cloth to my feverish soul.
And now, standing here, I too could sense their hope, sense why the woman who was human fishing had been smiling so much. I wished, if the mom outside hadn't left for the hospital already, that one day she would sense this too, or better yet- now.
The song continued, until I was saturated, filled up again with a spirit other than my own. Mine was tired, but this had moved in, and it was lifegiving. Mine was sad, but this held promise. Mine didn't know what to do anymore. But this, said rest. Just rest.
So I did.
I relaxed, closed my eyes, and let it carry me away.
