Yin A Mat Po? (Are You Happy?)

The woman came to us with no living children. She had been pregnant twice before, but both pregnancies resulted in stillbirths. In the first pregnancy, she had labored for days, and the baby died during labor, but delivered vaginally. In the second pregnancy, she had pushed and pushed, but the baby did not deliver. A c-section was done, but the baby died anyway.

I cannot imagine what that must feel like. In the US, a stillbirth at term is a huge event. Privacy is paramount. A subtle sign is placed on the patient’s door so that the staff knows not to enter unnecessarily. A sympathetic nurse is chosen, one who will comfort the patient. Aggressive pain control is offered, because pain can only make grief worse. And the woman carries that loss with her for the rest of her life.

In South Sudan, it is unusual for a woman not to have lost at least one child. They die in childbirth, or they die later of malnutrition, malaria, infection, unexplained illness. I have seen women who have delivered 7 children, only to have 3 of them die, or delivered 4 children but having only 1 living child. When a woman arrives, the first question asked is “How many children have you had?” The second question is, “How many are alive?”

It may be a part of life here, but it would be hard to argue that these women suffer less. I truly cannot speak for them, nor know what they feel, whether they have different expectations or a more effective way of processing grief than we do. But in my opinion, grief is grief, and whether you acknowledge it or bury it, it is there and always will be. It is only how you process it that differs.

I have noticed that there is a lot of psychosomatic illness here. One would expect that, given how tough these women are, you wouldn’t have a lot of non-urgent medical problems; that people would only come in to the hospital for really serious things. But in only 2 weeks here, I have seen 4 or 5 cases of “hysteria” – in which women completely collapse and are unresponsive even to severe pain (rubbing the sternum, pinching, etc), and when they awake, there is always a convoluted backstory involving family drama, traumatic experiences and sadness.

Other women have “total body dolor” (a term I learned in the Bronx) – generalized body pain with no apparent source and no real description. Often, they will fully admit that they are having major emotional upheavals for one reason or another, and they will agree that the pain is probably related to the emotions. This is an astounding degree of self-awareness that I wouldn’t have expected. Often I give them Tylenol or Ibuprofen and, depending on the severity of emotions, a mild sedative, and let them rest in the hospital for a day or so for TLC (tender loving care). Everybody needs a damn break sometimes.

So I think that the deaths of their infants do affect these women in one way or another. They are extremely stoic. I have never seen a woman who lost her baby (and I have already seen many) react with tears, or even a facial expression indicating sadness. It is really mind-blowing, because I would probably be inconsolable, and loudly emotional. But there is an incredible cultural factor at work here, I guess, and emotions don’t seem to be expressed on the face.

We examine the woman with two previous losses, and decide that her pelvis is terrible and no baby will fit through it alive. She should have a c-section. Although it means that she will be having her second c-section and will now require c-sections for any future deliveries, it also means she might finally have a living child.

Intaoperatively, I am glad I decided to do the c-section. Her pelvis is tiny, like many of the women here, and I have a hard time even getting my hand in there to lift out the baby’s head. The baby cries right away; it is a girl. I clamp the cord twice, and hand it over to the waiting nurse. The baby is cleaned off, examined and wrapped in a towel. Katie, the Australian midwife, brings the baby to the mother’s face so that she can see her while we are finishing the c-section. The mother makes no expression, but tears roll down her face when she sees her healthy baby.

As the surgery ends and we take down the drapes, I try my few Dinka words on the woman.

“Yin a pwal?” I ask. (Are you OK?)

She nods once. No expression.

“Meth a pwal?” (Is the baby OK?)

She nods once. No expression.

I ask the nurse to ask her if she is happy.

“Yin a mat po?” he translates.

She answers.

“She is happy,” says the translator. She still has no expression.

I take her at her word. It is sometimes a challenge for me to have so little emotional response from patients. I realize that I am accustomed to my own culture, and even Ugandan culture, which I have more experience with – both have a lot of reflexive smiling. When you make eye contact with a person, the first instinct is to smile.

I find it harder to connect here, where people make eye contact, but not a single muscle in their face twitches, and they feel no obligation to acknowledge the connection. I try to wrap my mind around it; what does it mean? How does it evolve? The South Sudanese staff that I work with has been very warm and friendly, with smiles and handshakes. Sometimes strangers respond to eye contact with smiles, but infrequently. Smiling is clearly not a cultural expectation. But most surprising of all is a patient you have just operated on, to whom you have given a very happy, very desired outcome. They have no obligation to smile, but it is hard for me to understand how anyone could suppress a smile at a time like that. I have come to learn not to expect it, and not to worry about it, but it is fascinating.

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19 Responses to Yin A Mat Po? (Are You Happy?)

  1. Kelly Scheideman-Ward says:

    Wonderful work and a challanging cultural experience! Thank you very much for sharing. I have aspirations of being a PA and joining the MSF team. Your experiences are a great inspiration to me.

  2. dhaval says:

    I wonder if in this instance, the reason why she did not smile was due to the fact that she recognized that the baby, even though it was born healthy, is not out of danger yet. What do you think?

  3. Meredith Beck says:

    I am so inspired by your blog. I am a medical student in America with aspirations of becoming and OB/GYN. These entries exemplify why I care so much about maternal health, having seen a bit of how poor maternal health can be when I visited Uganda.

  4. Rebecca says:

    A great blog and so true, which I too am trying to get my head around. We (Poole Africa Link) have just arrived back from Wau after working for a short period with the local doctors, nurses and midwives and even visited Aweil on our way due to the airport closure! I wish you well for your time there and will be watching your blog.

  5. deiya says:

    Dear Veronica,

    Keep it up!! We need more people like you :)

  6. Raquel says:

    Dear Veronica,
    You are delivering hope. To your patients and to us.
    Thank you.

  7. Raquel says:

    Dear Veronica, you are delivering hope. To your patients and to us. Thank you.

  8. will offord says:

    sometimes i wonder…you my lady are an exceptional human being.you give hope and your effort is priceless. our planet continues to turn because good souls keep striving and do not quit until someone is taught to carry on. i am proud of you.i will share your story with many.be safe.

  9. dominique says:

    all it does is make me sad. thats all.

    stay safe.

    God bless.

  10. Freche-gois says:

    Dear Veronica
    I feel with you, I have been working in Aweil Civil hospital in 2009.
    I feard that many of our patients must have experienced some sort of physical and/or psychological violence. Being there and offering assistance and a place where they can seek help is worth soooo much.
    Keep on doing what you are doing. It’s always worth it although it might be just a drop into an ocean.
    Be safe

  11. Lhynn Nevarez says:

    Hi, I I have noticed for years alot of folks in the US are lacking the compassion this country once had..so when i read your story I was so happy to see you were doing this and caring about all the Sudanese..Thank You for being there and caring..They thank you also!!

  12. maureen says:

    Thank you for sharing the pain of these unfortunate women you have treated. It puts us into good perspective with regards to the degree of loss and pain we are experiencing here in comparision to what other less fortunate people are facing elsewhere each day.
    It has brought back into my memory as to why I had decided to work in the area of medical care long ago. Thank you.

  13. Amanda says:

    You’re an amazing doctor and and writer, keep sharing your gifts. Xx

  14. Amanda says:

    You are clearly not only an exceptional doctor but an exceptional writer. Keep sharing your gifts. Xx

  15. muhammad sabiq says:

    i’m very interested with this kind of job…
    its not my life working in hospital…
    prefer rural area, living with people…
    but i dont have any idea how can i got involved in this world..
    i’m junior doctor, just working for 1 year plus…
    currently i’m in labour shift , labour room..

  16. shevon says:

    I love reading your blog. I am an L&D nurse and have applied to work with MSF. Your blog is giving me a small glimpse into what I am about to undertake. I admire your work and your desire to serve others. Keep up the great work and the engaging blog posts.

  17. Paroeshka says:

    Hi there

    My cousin is a second year med student and she wants to be a gynie.

    She told me about your blogs and I promise you read them all in space of 2 days.

    I am 30 yrs old married and have had two misses already but have a wonderful 1 year old Adam.

    Eventhough I have had my misses between 6 and 8 weeks of pregnancy it still hits me hard.

    I think about them all the time and I long to be pregnant again.

    I just want to tell you I admire what you do and thank you so much for helping those ladies.

    It makes me very happy to know you care and you doing your best to help them.

  18. obituaries says:

    Many mistakes can be made by omitting names or information or by misspelling words or names. And less obvious errors might be omitting important facts about the deceased. Check and double check your facts and keep a check list to ensure what you’ve written is accurate.

  19. ayearinskirts says:

    I am mesmerized reading your blog and learning from these incredible experiences that are so different from life in the USA. You’re doing good work there, and here. Thank you.