Warning – this is sad. Don’t read if you’re already not having a good day.

[note: this is posted from Ndola - since I didn't get to an internet cafe in Lusaka. More on Ndola soon...]


I am back in Lusaka for a day before heading off again – this time to Ndola, the site I proposed in the very beginning. Ndola does not have a rural catchement area. Instead, it is smack in the middle of the Copperbelt province, one of the richest, I hear, due to the copper industry that funds most of Zambia. With the advent of wi-fi and silicone cables - and the reduction of copper cables being used – this province in Zambia has apparently been through some major economic shifts and down turns in the past decade or so – and is now just starting to rebuild. There is an anthropological look at the social ramifications of this down turn by James Furgeson called Expectations of Modernity. As a non-academic-anthropologist, it is a bit hard to get through, but the parts I’ve read have certainly been interesting – and I’m curious to see the capital city tomorrow.

My last 2 days in Choma had a strange air to them – there was more death than there should have been, that is for sure. There was a maternal death on Thursday night. Her baby died as well – both from a ruptured uterus diagnosed too late. I met the woman during my evening – when I had said I was returning to the hospital. When we arrived, she was 8cm and screaming. Then she got really really quite. Unsettlingly so – and curled up into a ball except when she sat up to vomit. With the weak stomach that I am known for, I often left the room when she was vomiting – having a bad feeling about the whole situation. This was not the typical transition vomiting that women are want to do before finally pushing out their baby. The midwives were aware that her condition had changed. In my field notes that I try to keep during each day of observation – I wrote “The midwife just came in to call the doctor – she said ‘her skin is cold and clammy.’” Her BP was stable, but something was obviously wrong. I did not know HOW wrong it is – but will NEVER again miss the obvious signs of a uterine rupture. I never put my hands on her. I never felt her fundus. I asked for her consent when we arrived so that I could observe her delivery – which she sweetly gave and signed the paper herself. I don’t know what to do with that paper now. Realizing that she was more sick than about to have a baby – the RA and I left, as it was late. When we arrived the next morning – and asked how she was – we were told she had died on the OR table (in theatre) – at about 12:30. She had ruptured. The baby was dead and high in her abdomen. She was in shock. I almost threw up.

That day, a premature baby was born. I think it was about 28-30 weeks gestation, but the young mom did not know her LMP(last menstral period) and came in at 7-8cm dilated. Anyway, there are no tocolytics, so if she’s in labor, she is going to deliver here. The baby was born – Apgars about 4 and 6 – meaning the baby was limp, but breathing. It was weighed immediately (yes, that usually happens here before the placenta is out or the oxytocin is given) and was 1.3 kg – which is 2.9lbs. After an hour, an oxygen tank and adult size nasal canula was brought in, and put on the now blue baby – that the midwife had tried to resuscitate with the resources available. The oxygen was taped on to the tiny face as best as it could – and I watched the baby throughout the day – continue breathing. Knowing the value of kangaroo care for premature infants – in both low and high resource settings (where the baby is kept next to the mother for warmth – instead of on the artificial warmer wrapped in blankets, as all neonates are here – I asked if the baby was ready to go with it’s mom for Kangaroo care. The midwife told me that no, this baby (whose oxygen had just been removed) needed to stay on the warmer for ‘observation.’ The only trouble was that it was all alone, and rarely observed, because the midwives were busy doing something else [side note- usually 2 or 3 midwives and no nurses are responsible for all admissions, discharges, complicated antenatal cases, post partum mothers, laboring mothers, and referrals including pre eclampsia, eclampsia patients, and any one else who is pregnant and walks through the door]. I tried to keep watch as best I could, but left around 5.

In the morning, I returned, and saw the mom. “How is your baby?” I asked her as she was walking to the bathroom to bathe. “My baby is dead.” She said. Her eyes welled up with tears and she turned away. Again. I went to an empty bathroom and cried. I do not know if I could be a midwife here. There were other stories, but I won’t go on.

So – 6 deliveries were observed in total during the 3 days in Choma – but I have to say, I was ready to leave when I was picked up on Saturday afternoon. I feel guilty walking away – without having done anything really to help. I put on a pair of gloves sometimes to help a midwife hold something, or pass her something – or adjust the oxygen on a baby – but I have not really helped. I don’t even know what I would do. Make recommendations? As if that’s enough.

I hope Ndola will not bring with it the witness of so much sadness. But this project trecks slowly on – and I have almost reached my target for numbers in both interviews and in observations. I am ready to see some elephants, giraffes, and stare at the wide open and star filled sky for a bit.