Fieldset
Previously Inconceivable

I hear phrases here that I never imagined possible.

“We don’t care if the baby lives.”

“I don’t care if my wife bleeds to death, she is worth nothing without her uterus.”

“We have enough girls, can you find another home for her?”

I hear phrases here that I never imagined possible.

“We don’t care if the baby lives.”

“I don’t care if my wife bleeds to death, she is worth nothing without her uterus.”

“We have enough girls, can you find another home for her?”

“It’s better she stay here and die here, than transfer and die, even if there is a chance she could live if we transfer.”

“I have to get pregnant, or my husband will find another wife.”

“Am I really in menopause? Praise Allah, I thought I could be pregnant with my 25th child!”

“I’d rather she die than have a Caesarean.”

“You only become a real man once your wife gives birth to a boy.”

It’s a strange reality for me, to be confronted with such a blasé approach to mortality. I’ve grown up believing in the sanctity of life – that all life is precious and we should do as much as possible to prevent death. But due to a multitude of cultural factors, mortality has taken on a whole new meaning in this part of the world. It is I who must change my beliefs and coping skills to survive in this environment.

I hear myself saying things I never imagined possible.

“If you care if the baby lives, we should do a Caesarean urgently. If you don’t care about the baby or want to avoid a Caesarian, we can just wait to see what happens with the labour.”

“She will bleed to death without a hysterectomy. Let us save her so she can care for your living children. You can find another wife to bear you more children.”

“There is nothing wrong with this girl. If you keep her she will become an asset for you.”

I hear myself fail to develop a response to answers I never expected. Sexism, racism, negligence and maleficence. Doses of dangerous drugs that make me gasp. No wonder some patients arrive in such a pitiful condition. Malpractice is common with some external healthcare providers, while negligence is a common response to a woman of low ‘worth’. There are many other women available to marry if this one does not survive.

I am calmer now than I ever was back home, when faced with a baby with a low heart rate during labour.

More often than not, the family just wants to see what happens naturally. They refuse the medical help I offer.  There is no point in raising my own heart rate and blood pressure in response to the adrenaline. I no longer need to react quickly and precisely to save a life. I have learnt to go with the flow; see what nature has in store for us. I have now witnessed how long babies can survive with lack of oxygen, or how a mother can haemorrhage, yet survive. I hope this will result in excellent ‘perspective’ that I can use to my advantage. But when I go back home, and the pressure is on again to save lives, will my new-found tranquility remain?

I hear some phrases, which I know are spoken the world over.

“I will resign if you do not approve my annual leave.”

“I don’t know how that happened.” (While looking very guilty)

“You must see my patient now!”

“Why am I not entitled to overtime pay?”

My new reality is not that different to the old.

I still chuckle when I hear the cow mooing over the hospital compound wall. I still take note of the ‘put-put-put’ gunfire in the street. Every loud bang is a potential bomb blast, with the initial reaction that I should go to help in the ER. I still feel the need to laugh at some of the dramas I encounter day-to-day, to prevent myself from crying. I always seem to perform a vacuum-assisted delivery (we have electrically-powered suction) precisely when the power has blacked out. I will forever marvel at the patients who leave hospital against medical advice, with such serious conditions. Labours that are profoundly obstructed. Profuse hose-like bleeding. Normal, healthy patients demanding interventions. I will never forget the innocence of patients that can only stem from living a traditional lifestyle with no modern intervention.

It is the small things that really make my day, while also reminding me of the stark contrasts in culture. For example, after a ‘games night’ with the other expats, we forgot to pack up the Twister mat. When we returned home later the next day, we were faced with our resourceful cleaner’s interpretation of the use for such a sheet of plastic indoors. We can only assume she has never played Twister before.

Innovative use of a twister mat © MSF

Innovative use of a twister mat © MSF