Lines in the dirt

When we left the hospital three days ago we left a seventeen year old in active labor. She was 9cm, fetal heart was great, and we had spent the day laboring with her. She was open to walking the halls, singing, massage, and we spent moments between active pushing as her doulas. She had a group of women with her, her mama and her father’s five other wives- also her mamas. We assumed we would arrive in the morning and get to meet her baby. Instead we were told she had needed a cesarean and the baby had died. The story from the Doctor was that he had been called in the morning because her labor was obstructed. The story from the women on the hall was that she had become fully dilated around 10 at night but was having trouble pushing properly. The midwives told her they would hit her if she cried and to call them only if the head was coming out. Then they went to sleep. At 4am, her mother woke a midwife in a panic. Her daughter was asking them to bring a hoe, which in Acholi culture is a sign of death. Sure enough, the midwives checked and the baby’s heart rate was dangerously low. The head had been in the vaginal canal for 6–8 hours. The doctor was called but he did not pick up his phone. Another was called but he said he would not come until morning. A 9 in the morning a cesarean was done, and the baby was dead.

We spent the day trying to find out the real story. In the report book it stated that the mother was ‘found’ in second stage of labor and that the baby was already dead. I know this is not true. Aimee and I (but mostly Aimee) labored with this woman and her live baby all day.
When we visited her, they had not yet told her that the baby was dead. Instead, the doctor told her the baby was very sick. His explanation was that he needed to prepare her, the shock of finding out her baby had died would be too much, so this lie was to ease her into the loss. She lay on the bed with a puss filled incision, her eyes darting back and forth, her breathing shallow, her pulse quick. We sat with her and cried with her and when she asked us to please make sure her baby was ok, we didn’t know what to say.
But I did know the hospital, the current system, was responsible for this babies death. Neglect and lack of action. I felt an anger that was deep. A sense of right and wrong violated like a line drawn in the dirt, blurring and more and more people step on it.

Day two. We return after a sleepless night to find this mother in septic shock. She learned her baby had died, shit herself and cried until she passed out. Now she is completely unconscious, has a raging fever, her stomach is distended, her breathing is shallow, lungs filled with fluid and her eyes are rolled back in her head. She will die unless she is transferred to another care facility. She too, is being neglected. The lack of management in this hospital mixed with apathy and trauma of staff makes for a standard of care, a culture of care, that is dangerous. The midwives are as traumatized and sick as the patients.

We spend the day arranging an ambulance to another hospital. Aimee pays for the gas. The family stands vigil around this young mama, they lay a bible on her head and pray and pray and pray. I begin to cry and have to step out of the room. She is only seventeen. We get her in the ambulance. All six mamas, her brothers, her husband, Aimee and I crawl in with her. She is on a straw mat on the floor of an old ambulance that has to be roll started. We have to straddle her to hold her still as we crawl through the unpaved and bumpy streets. A stop for gas and a half hour later we arrive at another care facility where she is immediately attended to with IV antibiotics, clean equipment, two doctors and three nurses. She is transferred to intensive care with a fighting chance for life. For the first time in two days I feel like I can breathe. This hospital has no more supplies, but strong management and a culture of caring.

Returning to the hospital much has happened. A woman has died of hemorrhage. Another woman who we worked with earlier in the week has had a cesarean and her baby is dying on a table. I feel the trauma of the day in my body. My neck begins to spasm and I am tired. I place a shaky hand on the baby’s forhead, she has a raging fever. The nurses seem indifferent. Please I beg of them, call the doctor, this baby needs help. They stare at me blankly, it is night time. They will get in trouble if they call the doctor unless it is an ‘emergency’. A dying baby girl is not an emergency. I hold this baby and with a broken bulb syringe spend time suctioning bloody mucus that has already become infected. I drip clean water into her mouth and place cold washcloths on her forhead.

I felt the urge to lick this baby, like a cat, take her, inflamed, in my mouth , soften and clean, until it doesn't hurt anymore.
The baby gasps, I think she has died, and then she breaths again. Softer.
Here I am, miles from home, in Uganda, where the dirt and the heat
blend my sweat with my tears
my hands
her skin
desire to lick
take her in my mouth
that urge
to draw closer
saliva
and moist cheeks
dried by the sun
and I wonder
if it will ever be right
or if it ever was
and how I come to know myself
enough to
figure out
the difference
between the spaces

the difference
between a lick
that heals
a lick that cleans
and a lick that draws lines in the dirt

I send out a text for those closest to me to pray for her. The response is enormous. My father is holding the torah for her. Clare and James are sending Reiki. My girlfriends are praying. My community is so rich.
When I get into bed though, sleep cannot find me. I feel panicky. My back hurts and the foam mattress feels absorbs my shape, my tears, my sweat. I finally sleep and wake to a cold shower and strong coffee. Human resiliance is truly amazing.

The line between right and wrong is a relative line depending on which side you stand. I feel the pull to understand and the pull to trust my instincts because it is the only way that I know how to function.