Sunday, December 11, 2011

Examining Vaginas and Birthing Babies

Within the last week I’ve weighed babies, examined cervices, seen a birth, tested blood for HIV, and sat by the fire every night with my host family.  Sometimes I have to stop and think about how different my life is here.  Bizarre, but wonderful.

I did the baby weighing at the health post along with nutrition counseling for mothers with babies who were below the healthy zone.  It’s important that mothers only give their babies breast milk for the first 6 months, and I’ve found that a lot of women say they’re doing that but are not in actuality.  Kaba, the matrone, told me she caught a mother feeding sugary tea to her baby.  One of the men in my village told me that a baby recently died of malnutrition, so I want to make sure I’m able to inform mothers if their babies are underweight.  Infant mortality is high in my village, but I rarely hear about it.  During an intake interview with women for a recent cervical cancer screening, I had to ask the women how many children they had and how many times they’ve been pregnant.  I found that most women would report that about half of their children had died.  This isn’t talked about, but it is a harsh reality that needs to be addressed.  When I had a heart to heart with the man who told me about the infant who had passed away, he also told me that his first wife had died in childbirth.  During my baseline survey, I felt so optimistic about the maternal and child health of my village, but I am now finding that reality may not be as rosy as villagers would like to paint it. 

Three midwives came down from Saraya to do cervical cancer screening in Nafadji.  Earlier in the week, I told the presidents of the women’s groups about the screening, and they spread the information around the village.  On the day of the testing, I walked around the village, trying to get as many women as possible interested in being tested.  During the screening, I assisted the midwife with the screening by holding the flashlight on the vagina while she put vinegar on the cervix.  We both analyzed the cervices and gave the results to another midwife who did the counseling afterwards.  We screened 24 women, and hopefully will soon be able to provide cryotherapy treatment for those who tested positive.  I was worried that it would be awkward for me to be examining women who I know in my village, but it turned out to be fine.  Although I asked Mbamoussa to get tested, and her screening was slightly awkward for both of us since she’s my sister.  I was impressed with the amount of women who showed up, and the screening went smoothly.

With all the work I’m doing with maternal and child health, I’ve been really interested to see an actual birth.  I mentioned this to Sarr a few months ago, and he told me that I could help with one as long as the midwife was ok with it.  The midwife told me she’d call me when the next birth was happening, but somehow it never worked out that I was in village during births.  During the cervical cancer screening, I was in the maternity, and Khadidia, a pregnant woman, came in and was having contractions.  The midwife told her to go home and come back when they were hurting really badly.  She came back right as we were all going into the main health post area to eat lunch, and she lied down on one of the beds in the maternity.  After eating, I went back to the maternity to do an intake interview with a woman who wanted to be screened for cervical cancer, but the other midwives stayed in the health post to relax a little.

All of a sudden, I heard Khadidia screaming from the next room.  I rushed in, and the baby’s head had already started coming out!  Since I had no clue how to deliver a baby, I ran as fast as I could to Madame Diop and told her to hurry over.  By the time I got back to the maternity room, the baby was fully out.  I was amazed at how fast it all happened.  I worked as Madame Diop’s assistant and handed her different tools for cutting the umbilical cord and sewing up an area that must have torn.  We caught the afterbirth in a bowl and gave it to some village elders who came to pick it up.  It was incredible to see the baby girl enter the world.  She kept reaching out and grabbing the air, exploring her newfound freedom.  The birth was very messy and didn't smell great, but it felt so amazing to be apart of it!

Births here are so different from those in the US.  In a US delivery room, I picture a woman with a cheering section beside her, or at least friends and family waiting at the hospital to congratulate her.  This American woman is giving birth in a sterile hospital room, where supplies are readily available, and if anything goes wrong, there are the resources to get the baby out safely.  Painkillers are an option to keep the mother more comfortable, and a nurse takes the newborn to wash it and wrap it in a blanket.  The mother was not expected to bring her own cleaning supplies or sheets for the bed.  After the delivery, the mom is able to rest for a while in the hospital room. 

Here in Senegal, Khadidia came to the maternity just as she was about to give birth.  No friends or family were in the room with her, and the room was far from sterile.  I was racing around looking for a fresh pair of gloves and alcohol.  All the blood was wiped up with the pagne (fabric skirt) that Khadidia had arrived in.  I watched Madame Diop stick a metal hook in Khadidia’s vagina to sew up a tear, without any anesthesia.  After the umbilical cord was cut, the baby was placed on a table and wasn’t washed.  If anything had gone wrong, we were 90k from the nearest hospital that can provide a C-Section, and there are no cars in my village.  Directly after giving birth, Khadidia went back to her home with the new baby.  After seven days, there will be a baptism, where the baby will be given a name.  From what I observed, as long as there are no complications, delivering a baby is very straightforward.  Maybe all these differences I’m mentioning shouldn’t matter as long as the mother and baby go home safe and healthy.  It’s when there are complications that problems arise that the health post is not equipped to handle. 

The following day, the Saraya hospital car picked me up in Nafadji, and we went to Toubacouta, a small village in the bush, to do HIV testing.  We picked Ian and his nurse counterpart up along the way to go to the testing.  Ian and I did the blood tests, and we found a couple positive ones.  The Saraya team includes a social worker who provides counseling to individuals when they find out their serological status.  Fortunately, antiretroviral drugs are free in Senegal, but the treatment for resulting infections is not.  HIV status is not public knowledge, and the hospital is very good about not revealing those who tested positive.  Only a few people at the hospital even know who the HIV positive people are in the region.  The social worker seeks those people out to encourage them to take antiretroviral drugs.

Now I’m back in Kedougou and am about to start my journey home to the US.  Yesterday I biked to Saraya with my luggage strapped to the back, and my back tire blew halfway through the ride.  I flipped my bike over and changed my tire tube with tsetse flies attacking me.  As frustrated as I was, I knew I was on my way home.  Luckily, the second tube worked out and I made it to Kedougou in one piece yesterday.  I had a weird feeling of sadness as I biked out of my village.  I’ve been looking forward to going home for a while, but I really will miss my village while I’m gone.  It reminded me that I’ll be leaving for good next year, and that is going to be incredibly hard. 

Right now, it’s the “cold season” in Senegal, which means temperatures can drop down to 70 degrees.  I know what you’re thinking.  Anyone who thinks that’s cold must be insane, right?  But after adjusting to the climate here, I actually get goosebumps at night and need to wear a sweatshirt, and my family has been sitting around a fire every night before bed.  I have a feeling I’m going to freeze when I land in Seattle!

Tomorrow night, I’ll take a night bus to Dakar, and then the following night, I begin my 30-hour voyage home on 3 different planes with long layovers in between.  I’m so excited to come home for the holidays!  It’ll be nice to eat some good food and hang out with friends and family.  I feel like this trip home has been something I’ve been working towards for so long, since I booked this flight back in May.  I’ve counted down, and the idea of seeing my family again for the holidays got me through a hard time at the beginning of my service.  Now, it’s actually here!  Where did the time go?  I can’t wait to be home soon!


  1. Its clear and 38 degrees in Seattle right now. The mountains have good snow for skiing. Pickup soccer 5 days a week. We picked up our xmas tree yesterday and are stringing lights today. But we are waiting for you to come home so you can help us put on the decorations. We can't wait to see you. Travel Safe!

  2. Incredible stories--it is so amazing to hear about all of them! Can't wait to see you! xoxo Mom