Ah, prenatals. The backbone of midwifery care. Let me tell you, after doing days and days of these, the one thing that sticks out in my mind is that mi amiga Jodilyn would be tearing her hair out. A model of efficiency and order they are not. But, like everything else here in Uganda, if yo u can let go of any expectations, (and I mean ANY) they can be a heck of a lot of fun.
They happen every morning. Sometimes. There are two midwives on duty each day at the clinic, and shifts run from 8am to 6pm and 6pm to 8am. Sort of. Staff comes when they come, and nobody is the least bit upset if their relief is an hour late. Or an hour and a half. Or two hours. Can you imagine that happening in the US? Blood would be shed.
Now, to their credit, It is very difficult to get here from Kasana Town. It is actually a lovely 30 minute walk, which I enjoy very much, and the red dirt road is not too treacherous. But as it is the custom to greet everyone you meet, and if you know them at all, there are long and involved exchanges, which have to occur or you are considered incredibly rude.
-Hello,how are you?
–I am fine. And how are you?
-I am fine too. How is your wife? How are your children?
–They are also fine. They slept well last night.
-That is good. That is very good. I, also, slept well last night.
-That is very good.
Now, imagine that times everyone you meet. If you are very lucky, you can get away with a quick “Olyotya,” (How are you?) and an ever quicker “Jendi,” (I am fine) and keep walking. But not usually. No wonder it takes an hour to walk 30 minutes!
Once the staff is assembled, and everyone has been asked after (“Jane, how are you? And how is Anna? And Rachel? Are they feeling well? Will they be coming to Shanti today? We are so glad they are well. We are also well.”) it is time to get the day started. Ha ha! I kid. It’s really time for breakfast. Today Annet, an extremely bright young midwife, has already brought me boiled corn, chipati (sort of like naan bread), and a steaming hot mug of millet porridge, which she prepared on the Bunsen burner. It is so yummy, and I am so spoiled. Yesterday I brought pineapple to share, but that’s really not as impressive.
Now its time to get some midwifing done. Well, some cleaning, at least, which, we all know, is an integral part of midwifery the world over. The clinic’s floors are swept and mopped, the linens changed on the prenatal beds, the chairs wiped down, and many other things I’m sure I missed because I was too busy eating delicious porridge to notice.
Then we wait for clients. And wait and wait. Sometimes the come, sometimes they do not. Yesterday was a good day. We had five clients, one of whom was new. And each one took an hour. Now, at home our prenatal visits can easily take an hour, but this is because we are doing Important Midwife Work, like reaching into their innermost souls and connecting with the Divine Feminine. Here, it is most likely because the lab tech is late, so we have to run each lab ourself, or because each chart note has to be entered into three different places on ten different forms. But, as always, nobody minds waiting.
I can easily see at least ten ways in which this process could be sped up, but I’m not sure that’s the point. As the clients wait, they chat with each other, they compare notes on their pregnancies, the older mothers counsel the younger mothers, and the passing of knowledge from one generation to another continues. I keep using the word community, but I can’t come up with a better one. Its normal, natural. There are no “community building exercises,”" no block parties, no art walks. Not one single thing to make people meet their neighbors and care about them. And yet, it’s here. Maybe all the greeting is worth it.
The process itself is familiar, the nutritional counseling, the blood pressures, the palpation. The midwives here are not taught in school how to palpate for position or lie, but they have had some training in it from a Canadian midwife who was here a few months ago. They do have extensive knowledge of birth positions, and so one of my goals here is to help them integrate this knowledge.
They have to learn to find the position of the baby in labor, and figure out which position will help the mother birth mostly easily and safely. Now, of course, most of the time, the mother’s body will tell her what position she needs to be in, but, just like at home, sometimes there are malpositions and puzzles which must be solved at the birthing time. Prenatals are a great time to practice palpation, for everyone. And of course, Ugandan mamas love to know what little baby parts they are feeling, just like American mamas. It’s just another fun way for the mother to bond with her baby, and for me to bond with the mamas.
Sometimes I think I prefer to do prenatals in a foreign language. It is just a riot and leads to so much laughter. Clearly, I am not from here, and clearly, I am clueless in Lugandan, the local tribal language. And, some of the prenatal protocols are just hilarious. Everything is written out very clearly, every step of every exam. Now, I appreciate thoroughness as much as the next girl, but how can you not love that you have to check a box that says “Limbs. Lower. Both present?”
(Now, now, my politically correct friends. I know. Its bad and tragic when mamas have only one leg. But it is about as common here as in Seattle. This is not landmine country. I’m making fun of the form, not the people.)
The mothers here are young, of course, but mostly married, which is good for economic stability. They are poor, but everyone is poor here. We do a lot of nutritional work, of course, and the mothers are taught a few birthing positions at each prenatal visit, so when she is in labor, they are familiar. They are also shown stretches and yoga poses. Imagine me, She Who Does No Yoga, on hands and knees demonstrating cat-cow. Down goes my back, and I bellow,”MOOOOO!” Up goes my back and I screech, “ME-OOOWWW!” Its poetry in motion I tell you.
All in all, prenatals are a happy time. And who doesn’t need more happy times?