Monday, June 16, 2014
A reflection from Neila Bazaracai, Medicine Class of 2016
The first thing that Tanzania changed was my sleeping habits. Accustomed to the typical student lifestyle of staying up far too late doing far too little and having a love/hate relationship with the snooze button on those dreary Canadian mornings, I was shocked at how easy it was to fall into a pattern of waking up with the roosters and call to prayer and collapsing onto my tiny foam mattress, completely spent, shortly after sunset. Which is how I came to be, at 9:30pm on an especially chilly night in a small village on the base of Mount Meru, already ensconced in my mosquito net, reading by headlamp when my phone rang. I slid open the ancient white brick to reveal a text from Ismael, the midwife: "come now."
We had been in Tanzania a few weeks at this point. This was just long enough to get over the initial culture shock, pick up a couple of useful Swahili phrases, and learn how to use public transportation by hopping on the back of a dirt bike or cramming into a dusty minibus with about 40 other people. Having left behind the hustle and bustle of Arusha, a major city, two of my nursing student team members and I trundled up to Nkoaranga Lutheran Hospital for a more rural experience. When I received the message to come for the delivery, I quickly exchanged my pyjamas for a pair of scrubs, made sure my headlamp was firmly affixed to my forehead, and ran down the hill from the guesthouse to the labour and delivery suite.
"Already over," Ismael said with a shrug as soon as we arrived. Labour had progressed more quickly than expected and the exhausted new mother was now laying on her cot with her tiny gray baby sprawled across her chest, blood splashed casually on the floor around her. I stammered out congratulations in broken Swahili and turned to go back to bed when I heard moans coming from the next room. A quick peek inside revealed a naked pregnant woman writhing around on her cot. I asked Ismael if she was close to delivery and if I could stay for it. "She will deliver soon," he said, "but baby is dead. Comes too early." Before we could even absorb the significance of his words, he strolled over to the woman and beckoned me over. There, in a tiny metal crib beside her, was a baby that had been delivered earlier in the same room and forgotten under the warming lamp. He asked me to take the baby to her mother in the maternity ward to avoid upsetting the woman who was about to have a stillbirth. I picked up the precious package and headed down the cold, dark hallway to deliver her to her mother.
Returning to the delivery suite, I smelled it before I saw it; the ripe, earthy odors of blood and amniotic fluid heralded the baby's arrival into the world. I walked in to find Ismael kneeling between the woman's legs, holding an impossibly small crying baby, while a nurse rummaged through a purse on the sidelines. "The baby's alive!" I exclaimed, "That's great!". The nurse shrugged matter-of-factly, held up the mother's purse and the solitary banknote held therein, and said, "It can't live, only six months. Mama has no money to take it to Arusha."
The rural hospital we were in did not have a neonatal ICU, which this baby, born at 26 weeks gestation, needed to have any chance at survival. The closest NICU was in Arusha, a mere 20 minute drive away; to the mother, this may as well have been 20 hours. We were told the hospital car, the only car in the village, could take mom and baby to the hospital for 50,000TSH (about $30CAD) paid upfront. The baby had been placed under the decrepit warming lamp, the only thing the hospital could do to keep it alive just a little longer. The mother had already sat up and started getting dressed and gathering her things to go home.
We could save this baby's life for thirty dollars. It seemed to be a no-brainer, saving a life for the cost of a dinner out back home. I made the trip to Arusha with the mother and midwife. The baby was swaddled in a colourful piece of cloth beside a thermos of hot water and off we went down the mountain.
The moment we stepped in and approached the front desk, the receptionist eyed us up and down and asked, "who is paying?" I nodded and handed over the admitting fee, at which point mother and baby were immediately swept away. The differences between this hospital, a private one frequented mainly by ex-pats, and the other clinics in which we had been working was night and day. I asked if I could see the NICU. The baby was already cocooned in his incubator, a nurse fussing over him, in the modern, well-equipped room.
It was only as I lay in bed that night that I finally considered what kind of life this baby and his family was going to have. Despite the NICU's best efforts, it was still likely that the baby was going to suffer long-term consequences as a result of his prematurity. In all my excitement at being able to save a life, I had failed to think about the burden of a very sick child on a family with few resources, who may not have even wanted the baby in the first place. Despite all my moral misgivings against the white savior industrial complex and against the prevailing Western attitude of preserving life at all costs, I had given in to both in a moment of panic. I can only hope that my rash actions didn't place too big a burden on this family, and vow to consider all sides of a problem when faced with such decisions in the future.