Well…this is going to be raw, and parts gruesome, skip over if you must. I guess that is how it is supposed to be, and I am sure you will forgive me and work in a little slack. I am writing at the end of three days of horror, frustration, helplessness, anger, and hurt. A trying time in my service, and a trying moment in my life to be sure. It is a moment of learning, and a moment of development and growth. I am working through it, processing, releasing energy, gathering in positive thoughts and love, and regaining a foothold on the narrow path across the abyss.
There is a lot to process, and more to write about, and so little that can be properly expressed by the quick movements of fingers across warm plastic keys… Still, here we go. Strap in, put your mind at ease, and follow me into my own reflections and the reality that is my world.
I sat down and cried. Cold, iced wind blowing out of the south, pushing hard against my clothes and stinging down to the bone. The winter winds were here, but they were more a boon than anything else was. Sitting on the cold cement of my hut entry, I stared up listlessly, hopelessly lost in Africa. I sat and peered through the fragmented eaves of thatch, across the bushes of my compound fencing, and into the cold, clear, black skies. I saw through the edges of our world, into the dark abyss of the universe, and found it alive with color, thought, life, joy, and reflection. Bright stars reaching down, light of ages that have come and gone, reaching like silver fire, dancing across the heavens, gleaming in pools along the pathways of the gods, and as I can only imagine dragon’s talons might be, streaming down onto the world.
I wept at the miracle of life, and at the miracle of death. I wept at injustice, inequality, and suffering. I wept for loss, and for gain. I shuddered as I bore witness to this world. As clouds began to pass from the horizon across the deep dark bowl of the skies, I wept in darkness, as the lights were snuffed out, only to flare again with fiery fervor.
I wept so that I might not feel helpless. I shuddered so that I might be warm in a time when all felt cold and yet on fire.
I felt compassion, I felt longing… I felt fear for my own. I still feel each so strongly, but I am coping, processing, working through it, putting them ahead, seeing, and saying, “Yes! I accept you.” We are moving forward… and I am hurting. I am weeping now writing this, I am weeping as I tell the story and relate these feelings…and I am healing.
Let me share with you what brought me here. I know most of you have read, or remember talking to me about why I wanted to be a volunteer. That is in another place, you can find it here – Reflections on Service Choice and Volunteering, and it still holds true. I hope that you can return there, read those words, and understand why I came…but to understand the journey in its entirety, first we must process the now.
They say life is like many things… A roller-coaster, a river, a tree, a wave – well today definitely feels like that last one. I feel as though I’m a ship at sea, rolling through the waves, and facing a tsunami, or maybe Charybdis, sucking me down into the whirlpools of the abyss.
Monday started with a lot of hustle and hubbub. Rabble-rousers were…well rabble rousing. There were arguments, fights, screaming matches, crying, and finally by mid-day our program was on track and functional. Twenty SMAG (Safe Motherhood Action Group) members -3 from most zones and 2 from a few others- came together and began a week-long training on ante-natal, delivery, and post-natal health, prevention, and warning signs. As we progressed through the training, the men and women involved began singing, participating, and shining as only volunteers who know they will be able to save lives can.
By Wednesday, things had gained momentum and were rolling forward with a heady pace. The training was going great and the pupils seemed to be grasping the concepts quickly. I stepped out of the training and went over to the clinic’s makeshift screening room . That morning a young mother (20) who had three living children out of five pregnancies brought in a child wrapped in swaddling clothes no bigger than a 3-4 month old baby. Upon screening, the child’s age was announced at two years old. The mother claimed that she’d just taken a turn for the worse because she had malaria. The child was 6kg – 13.2lbs! Let’s step back a moment – 13.2lbs, and the height of a 4 month old at 2 years…. that baby should weigh 25-30 lbs at age 2. Then the swaddling clothes were removed and what remained before us was a living skeleton. Bone, gristle, skin, and glossy, suffering eyes, emaciated and wasting away. She did not even have the strength to sit up in her mother’s arms, or to cry. We quickly tested her for malaria, called the ambulance and evacuated her and her mother to the hospital. There she would at least receive IV and HEPS to try to get her back to a healthy weight, but the prolonged malnutrition will have damaged her for the rest of her life. If she survives, she will never develop properly… the worst part. The Mothers’ Logbook recorded that this was not the first time the family had brought in a child. Deep poverty means the whole family ran out of food – apparently often… Horrific.
Knowing we’d done all we could, we stepped back into the training and continued educating, stressing the importance of educating expectant mothers and fathers on nutrition, saving to help with clothes, food and other expenses, and health.
Thursday morning came around. We were back on track and yesterday’s difficulties were behind us – knowing that the child was safely in the hospital. A young woman was sitting in line waiting for the clinic to open for the morning. She was complaining of a backache and a headache. She was examined and found to be in labor. She was dilated to 2cm. four hours later (which you mother’s will know is RIDICULOUS!) She had delivered twins. I was called into the room and found the twins lying facing each other wrapped in a thick military surplus blanket. The nurse (untrained in infant/midwifery health) and the EHT were struggling to keep the mother’s health up and working over the crying twin. Unfortunately, the second was gasping, struggling for breath. The staff were not trained and they could not identify and treat the problem. As I stood, less than 2 feet away, they consigned the younger twin to God, and I, helpless and unable to assist, watched with horror as the younger twin suffocated, slowly turning blue and… facing his older brother, less that 4 inches away, he died.
The ambulance arrived minutes after but without trained staff. The mother, bloodied and unwashed, wrapped herself in a blanket, and as if in a horror movie, struggled to her feet and hobbled to the ambulance, leaving bloodied footprints on the floor. There she was given the blanket with her twins wrapped inside and the ambulance started off on the 45 minute rough journey to the hospital for further care.
Let me paint a clearer picture of the labor. The mother is lying flat on a cold metal table, curled up, straining as if trying to finish one last crunch, holding her own feet apart (they didn’t use the stirrups), pushing, in absolute silence. Not a single sound, moan, or scream. Then just 45 minutes later, is up and moving across the ward, down steps, through dirt and climbing inside a vehicle, bloodied, grieving, and stoic.
Watching the ambulance speed away, bumping and flying on sand and dirt roads riddled with potholes, the image of the two, wrapped and so close to each other, staring at each other as one died… burned itself clear into my mind, unshakeable, unforgettable… My mind drove straight to the possible loss of my own brother and the terrible fear, pain, and sorrow that would bring. I cannot explain what kept me going or allowed me to internalize and return to work.
We cleaned up, washed everything down with bleach solution, and got things organized. That included finding and killing 2 rats in the makeshift delivery ward!! The training finished and I retreated to my stoop, where I sat outside my hut and stared into the depths of the universe as I described early on in this post. I was trying to contemplate existence, the universe, and the meaning of life… trying to rationalize what happened, and utterly failing. I retreated into the darkness of my hut, listening to the wind against my thatch roof, and the whistle and chirp of crickets as the world turned without even blinking.
Death is so common here… it’s routine…. it is just another day. How do you rectify that inside of you?
I woke up Friday, steeled my will, and returned to the clinic. I had made up my mind to retreat to Mansa. I desperately needed to try and decompress; to process what I had seen, and been witness to… what I had been helpless to prevent or assist in. I arrived at the clinic to the news that another delivery was expected that morning. By 11:00 the baby was on its way and another volunteer watched the delivery. Her account of the process and conditions was basically the same. In this instance, the child was born with the umbilical cord wrapped five times around the neck. They called for help and thankfully one of the facilitators of the training was a trained midwife. The two facilitators rushed in, handled the situation, cutting the fifth loop, delivering the child and unwinding fate.
I left the building to be confronted by an argument. Two young children, maybe 12 or 13 were sitting being angrily lectured. I was called over to mediate and the situation was explained. These two had received a bush wedding and were here to attend ante-natal services. The 12 or 13 year old girl-child was pregnant… and worse yet, they were from the farthest edge of catchment zone – approximately 52km from the clinic. I need not mention the problems and difficulties they had ahead. Any hemorrhage, bleeding, or complication (which are all likely at such a young age) would leave her crippled, dying, and forced to try to ride on a standard bicycle rack 52 km to get help. I can only leave it for you to imagine the heartache and frustration of knowing the young girl would likely die. We stressed the importance of planning, of coming at least a month before her due date to the clinic, and then being referred to the hospital for a C-section or skilled delivery there. We forced them to make appointments with the SMAG members being trained from their communities, and entered them into the ante-natal bookings for palpations, vitamins, tetanus, iron, etc.
Heart-wrenched, feeling broken, helpless, frustrated, and hurting, the trainers closed the training, called for transport and we gathered our gear, and waited. 3 hours later, it arrived. We mounted up, stuffed ourselves in and started off. About 20km of the 56km to Mansa, we came upon a further horror. We saw a cruiser from a different district stopped at a strange angle in the road. As we approached the vehicle we saw that a man lay tangled in his bicycle. Half of his face was missing and blood was still flowing and draining down the asphalt. Passengers from the other vehicle were milling around the body. When we asked them what had happened, they were defensive. They told us, “He was drunk and fell over.”… How you fall over and have half your face ripped away is far beyond me. How can you tell a corpse was drunk when half his face is missing? When he is still laying face down, obviously untouched and unmoved as evidenced by the pool of flowing blood, how do you know he is even fully dead? Nevertheless, they were positive he was dead and positive he was drunk, claiming it was the work of liquor that killed him. You have to wonder how they could make such a determination without taking a pulse, checking the body, and at least attempting to resuscitate. We were hastily waved on and the driver accelerated us away before any other comment could be made or observation recorded.
As the sun set we pulled into Mansa. As the stars shone the other volunteer and I were dropped at the gates. With a cold wind at our backs we hustled inside to the warmth, comfort, and sanctuary of the Peace Corps Provincial House. Welcomed by our brothers and sisters in service….
After sitting, unable to sleep, tormented by the events of the last three days, it is 1 am and I am writing.
Here is the kicker I suppose. I know and can rationalize that my work in preventative health is saving future lives. That gives me great hope, helps alleviate the pain, and rewards me in my service. A passage from the Philosopher Hanh brings it back into focus. “Hope is important because it can make the present moment less difficult to bear. If we believe that tomorrow will be better, we can bear a hardship today.” I believe with all my heart that tomorrow brings new hope. Because of the work we are doing, and the work I am doing, tomorrow will be brighter than today… If I didn’t, my service would be empty and meaningless, and I would be utterly crushed by these last few days. It does not matter that the tomorrow I speak of might be 5 years, or 10 years, or 15 years down the road, or that the foundations I’ve laid and facilitated will be used and completed by generations yet to come… I know that the future holds a brighter day.
Thanks for listening.