Life and Death

Our Kenyan cousin Henry was expecting his first child in early November and he and his wife were kind enough to agree to let me support Marilyn (his wife) during her labor and delivery when the time came. Two weeks ago on Tuesday October 16^th, Henry called me around 6:30pm to let me know that Marilyn was having “pains in her stomach”. I asked a few questions around the type of pain and how often she was feeling pain, etc. to get a sense of her labor, and if it in fact was labor. I suggested he keep her comfortable provide her food and water and to keep me abreast of her progress. I followed up again at 11:30pm that night and then again at 6:00 am. During the 6am call, he said she was still the same but the pain was getting worse so he was going to take her to the clinic. I met them at the clinic around 7:30am to observe her as she coped with her pain. The doctor was nowhere to be found but apparently examined her and told her to remain at the clinic. No one seemed to know how far along she was or what the doctor found or observed in his examination. After observing her for a few hours and timing the grimaces on her face, it was my observation that she was not in labor so I proceeded to hunt for the doctor who examined her to get some more answers. The doctor finally surfaced and I asked him how his initial examination went and if she was effaced and/or dilated. I was not surprised to find out that she was not dilated but shocked that they wanted to keep her at the hospital when they weren’t monitoring her. I asked if it was possible for her to go home to rest but they refused to let her leave. She remained at the hospital throughout Wednesday, Thursday and Friday with no change and very little monitoring from the doctors – I was getting frustrated with the clinic at this point. Matt received a call on Friday from the EK emergency boat driver asking for help because the boat did not have enough fuel to take someone to Sindo, a town on the mainland where patients are often sent who need better health care. Come to find out, the doctors at the clinic referred Marilyn to Sindo for unknown reasons so Matt decided to pop in to the clinic to discuss Marilyn’s status with the doctor. The discussion was a frustrating one as the doctor agreed that Marilyn was not in labor yet still referred the family out of pure convenience and laziness. Apparently, he did not want to explain to the family members and family elders that she was in fact NOT in labor because he didn’t think they would understand. Instead of spending time explaining his medical opinion to the family, he felt it was better to refer the family to Sindo, which would have been a very expensive option – this frustrated me even more. The doctor agreed to let Matt “try” to explain to the family that she was not in labor. After a 5 minute conversation with the family also agreeing she was not in labor, Matt and the doctor discussed other possibilities for her pain and decided that maybe she had a UTI, which could be treated at the clinic. Turns out she was positive for a UTI but the hospital wanted to keep her overnight, again, for further observation. During the middle of the night on Friday a local herbalist/ traditional birth attendant snuck Marilyn out of the clinic to manually turn the baby (apparently this TBA thought the baby was sideways?) and administered some herbal treatment to induce labor (not sure which herbs were provided – I plan on doing some detective work to find out what herbs are given to pregnant women). She returned Marilyn to the clinic and early Friday morning Marilyn began to bleed from her vagina. Around late morning the baby was born. Unfortunately no one called me when she went into labor so I was unable to be present during her labor and delivery even after countless reminders to friends and family encouraging them to call me when she went into labor. No big deal except five hours later, the baby died and the only information the doctor provided was “the baby died of chest problems”. That’s it! No more questions, no more investigations, no information on if there were complications during the delivery, nothing.  I felt the wind leave my lungs and my heart skip a beat when Matt disclosed this information to me on the phone. Millions of thoughts flashed through my mind like lightning bolts such as “what could I have done differently”, “what caused the baby to die”, “Should I have stayed at the clinic all week”, “Were there complications during delivery”, “Could it have been the herbs given to her”, along with general frustration and sadness of the situation. I called Henry and our friend Caleb answered. He told us Henry, Marilyn and the baby were at his house and they were going to bury her that night. It was a baby girl. I hopped on a motorbike to swing by EK to pick Matt up and then headed straight to the house. We greeted Henry whose head was focused on the ground and a wooden ax he was carving to dig his first-born’s grave. We proceeded in to a dark candlelit house with Marilyn lying sideways on a sofa looking down at the ground where her baby girl lay. Tears formed in my eyes as I examined the facial expressions of both the baby and Marilyn, equally lifeless. I noticed how much the baby looked like Henry as I put my arm on Marilyn’s leg and looked her into her eyes to say “I am so sorry, I am so sorry this happened”. I sat in the chair across from Marilyn with the baby between us in respectful silence as family and friends entered and left to pay their respects. I walked out of the house to find Henry crying as he dug the grave. All anyone could do was stand and watch and force laughter when friends and family made witty comments to dilute the sadness surrounding the situation. It began to rain as the grandmother brought the baby out wrapped in a blanket placed in a cardboard Lido Soap box. A few friends escorted Marilyn to the grave and assisted her in standing. I can only imagine she still felt sore from the delivery of her baby just hours before. After the burial Henry brought some thorns and stones to place over the grave so the dogs would not be able to dig the body up. I placed some yellow flowers from a tree near the house over the thorns to beautify the baby’s grave just a little – I guess my Western mindset wanted to make the grave more formal than just a hole dug in the ground next to someone’s house. Matt and I shared some tea with Henry and the family before leaving and when we got home I couldn’t help but feel angry about the whole situation. From my observations, after spending multiple days at the clinic, it seems there is a lack of communication between patient and caregiver and vice versa. The patient and family often do not inquire much about illness or the medications given to them, and the doctors and nurses share very little, if any, information with the patients, which has created an oppressive culture in health care here on the island. I am also constantly amazed at the work EK is doing around health promotion and education and its mission to create a culture focused on empowering individuals to take a leadership role in promoting and educating their community on health related issues. It is my hope that the community continues to express interest in gaining more knowledge on how to promote better health care for their community and I am proud to be a part of such a movement. I hope that in the future, situations such as this, will be prevented by better communication practices, knowledge and health promotion.

Love and Peace,

Caroline