Kafue river with no fish

Outside Chipata General Hospital with the sun setting

Labor ward of Chipata General Hospital

Partograph and nurses hats in Chipata

The lovely Midwives at Kapata Clinic

I am sitting in one of the tackiest rooms I’ve ever stayed in. Brick-a-brack doesn’t begin to cover it. The under curtain is lace – the outer curtain is a fake patchwork of animal prints and bad drawings of the big 5 safari animals. The floor is tiled in a pink and gray tile that could be confused for dirty if you don’t look carefully and realize the gray splotches are part of the design. The over-stuffed love seat in the middle of the room is mauve and velvet and hard when you sit on it. There is a TV, a lamp and a dresser pushed up against one wall and a fridge pushed up against the other with bad painting of a lion hung 2 inches from the ceiling molding.

But – I love that I’m on the road. I’m sharing the room with one of the research assistants working on a complimentary project. She’s wonderful – an experienced midwife and trainer, who has been hired to help out with data collection. It is 7:30pm – and we are taking a break before we head back to the hospital to see if there are any deliveries. Apparently, July 10 is not a popular day to go into labor in Choma, Zambia.

I did watch one delivery today- the 18 year old girl – in my opinion – did wonderfully. But the midwives didn’t happen to agree. I watched, clutching my binder with data collection tools, as they yelled at her, and hit her legs and once her face when she was screaming, as she pushed. “she’s an un-cooperative gul.” One midwife said to me. I had to bite my tongue. Active management was used in that delivery – but I can’t say that I cared much. In just standing there and observing, I felt complicit in her meanness. I suppose these are the ethical dilemmas that the Downs committee encouraged me to think about – but meanness wasn’t on my mind then and I’m not sure I handled it well. I tried to compensate by telling her over and over what a good job she’d done – but I don’t speak Tonga – and I’m not sure she understood.

While that is the delivery experience fresh in my mind - I don’t want to paint that picture at all of the practices here. I have watched and interviewed some wonderful, skilled and kind midwives that put the lives of their patients (clients – as they call them here) ahead of everything else. They love active management, not because it cuts down on their work, but because they have said over and over that it truly cuts down on the rates of hemorrhage. They are upset when oxytocin is out of stock, and they reserve it for the clients at increased risk of hemorrhage when they are low. This has been the theme in all the clinics I’ve spent time in Lusaka, and in the clinic and hospital I visited in Lusaka.

Along wit the good – of course, I’ve seen the bad. After the discovery of a lack of fetal heart in a woman with polyhydramnios (too much amniotic fluid)– the doctor said “this is like the Kafue river – but with no fish.” People laughed. I did not. I also saw a footling breach (baby is born 1 foot first) that was ignored for a while. Unbeknownst to me, the mom was just laying on the bed with a half delivered baby….

There is very little labor management. Women are lucky to have the fetal heart checked every 4 hrs – as they are supposed to. There is NO Doppler, no sound of fetal heart in the room, and very little attention paid to the fetus. I have seen a few patients go to c-section (Cesar – as they call it hear) for fetal distress – but I’m not sure how they discover that.

As for the rest of Zambia – it continues to grow on me. It is a no-frills place in the most honest sense of the word (except the frilly curtains in my room). Life here is just life. Unadorned by crazy fashion, fancy food, and lots of hobbies. People are surrounded by death – and life – more than I am used to at home. There is always a funeral or a funeral procession – or talk of someone dying – and living – and life.

I have 1 more week of traveling and data collection – then the project slows down a bit when Caleb arrives. I feel that – while I have not analyzed the numbers – I have a good sense of what is happening in the urban and peri-urban clinics here.

I may just have found the answer to my question though...