Hope Rises

I heard the footsteps coming up the lane to our house, racing the rain, and I hoped futilely that they were making for the bush path that leads to our neighbor’s house (where sleep is not actually a thing). The knock and “odi!” pull me from bed and draw me to the door. One of David’s teacher colleagues is there. She lives by the clinic. She tells me that someone has collapsed. A few minutes later my own footsteps are racing the rain. I think on my way that I am so thankful for the series of events that landed us in our dear house with the purple walls right across from the clinic instead of a decent walk down the road. I also murmur a prayer of thanks for the slight rain, that cools the air and dissuades the mosquitos.

 It takes a good amount of Q&A to figure out what exactly happened and who exactly all the people present are as I try to rouse the unconscious woman. The most easily identifiable culprit, cerebral malaria, falls flat with a negative Rapid Diagnostic Test. I start an IV and run dextrose, trying to balance the possibility of hypoglycemia with the probability of exacerbating a hypertension problem with IV fluids. A car pulls up and the driver informs me that he has brought me a maternity case. I let them into the maternity ward then return to greet the ambulance, who came to pick up the unconscious lady, just as a second maternity case arrives.

Nine females in a room together: Two in labor— a young scared witless first time mom, and a veteran of five previous births. One a toddler and therefore wholly uninterested. One toddler’s mother whose relation to the aforementioned laboring women I’m still not entirely clear on. One wise old grandmother who kept putting gloves on (please don’t put your fingers inside of anyone, Bambuya…). One auntie. Two mothers holding and caressing their exhausted daughters, who appear strangely small and young and in need of their mommies in this moment for two girls about to become mothers, whether for the first or sixth time. And me.

The room smells of that curious mixture between bleach and blood. Both mommas progress slowly through labor at an almost identical pace, and I go through an entire box of gloves flitting back and forth between them. The younger of the two is in utter despair at the task before her but still feisty enough to cop a swing at the auntie who throws a tease her way. The other is taking far longer to progress than I expected, and my gut tells me something is wrong (but you can’t write “gut instinct” as reason for referral, so we press on). They labor through the night. I wonder at what point it is appropriate to begin using the greeting for “good morning”— 3am? dawn? Both of them vomit. Veteran Momma eats and drinks to keep her strength up, but Newbie Momma is scared and tired and won’t even take water. Between sips and checks and reassurances I slip into the back room and try to sleep for little spurts. When sleep won’t come, I pull out my yarn and crochet bunny slippers for the babies that are on their way to meet us, and in every stitch goes a prayer and a song. 

When dawn pushes its way through the dusty curtains that I haven’t gotten around to straightening yet (the string that holds them up is crooked and ohhhh the insult to my OCD), I give up on sleep altogether. My saint-of-a-husband drops by and deposits two pieces of french toast for breakfast on the table in the entryway, where they will remain for several hours until everyone gets done being born and stuff. Newbie momma delivers first, and between her relief and her extended family’s clamor I can feel the frustration and exhaustion of Veteran Momma, who has been laboring longer and surely has paid her dues for long deliveries with the first five births. Blessedly, she follows soon after. The cause of her complication and delay becomes glaringly evident, and I handle it to the best of my ability. The immediate danger is passed, but high risk of infection and Veteran Momma's general poor state after delivery prompt me to send my second patient in 12 hours to Mansa General Hospital. I pray an OB is on duty somewhere and will give her the attention she needs. As the car pulls away, I look down at my clothes and realize that I am wearing the body fluids of no less than 4 people (though 2 of them were less than an hour old, so somehow that doesn’t bother me as much. But still. Meconium everywhere). 

Prego moms and newborn babies are, in my experience, easily the most vulnerable people I encounter here. I’m not exactly sure how many neonatal sepsis cases I’ve dealt with in the last few weeks. Somewhere between 6 and 12. Umbilical cord infection was the obvious culprit in probably 90% of them. A couple weeks ago I carefully wrapped a 2-week-old boy and tearfully handed him to his devastated 18-year-old mother, who alternated between screaming the name of the child she had just lost and crying for her own mother. Not even an hour later, I welcomed a precious 3kg little boy into the world. That same little boy would be back in my arms 6 days later, fighting infection, spending the night with his momma in the same bed in the same ward that he stayed in the day he was born.

There is a deep and terrible beauty to existence here. It is raw. It is communal, and it is fragile. It is the jokes and jests of the half a dozen women who coached Newbie Momma through a slow and painful right-of-passage into adulthood. It is the surprising efficiency with which those same women sprang into action the second the baby was born, cleaning up momma and bed and wrapping up baby and disposing of the placenta. It is the deep searing tragedy of children lost before they ever really even had a chance to be, infants who slip away before they can even be named, as if somehow that namelessness gives them the peace to go, because they aren’t anchored here. 

It is all of those thing. 

And today, blessedly, it is life. It is a dainty precious baby girl and a hearty cone-headed baby boy. It is complications that didn’t complicate as much as they should have. It is improvisation that actually worked and laughter and joy to be shared. Today, it is hope, and it rises both defiant of and oblivious to the statistics or the hard of days past, because that’s just what hope does.