Before the sun even begins to rise, the day begins in the MSF Agok living compound. Inside my thatched tukul and beneath my canopy of mosquito net, my watch alarm beeps 7 o’clock.
Here in Agok there are actually many natural alarm clocks, the metal clang of the latrine door, the braying goats and crowing roosters, the laughter and deep murmurs of the security guards all prod me out of bed.
Sleepy "hellos" and "good mornings" are exchanged between colleagues as we brush our teeth at the communal sink before making our way to the Dining Tukul for breakfast.
There are a variety of breakfasts in rotation, my favorite is coffee with a very thin pancake which I recommend spreading with Nutella.
Walking to the maternity building I check to make sure my water bottle is filled, and another is already cooling in the communal refrigerator. The heat here is dry and constant. It’s easy to forget to drink enough water until you’ve realize you haven’t had to visit the latrine all day.
The commute to work is the best I’ve ever had, simply walking next door to the hospital where morning rounds are given regarding patient care during the night.
Mama Abuk and Baby Mara-Achai
The Maternity and Neonate Departments share one building. It is one of the few buildings in the hospital that has running water and electricity. Other patients in other departments rest in wards made of platform tents. There is no air conditioning, but we do have some slow turning ceiling fans that seem to have more of a placebo rather than a cooling effect.
Without a refrigerator in the department, medications which require cold storage are kept in an icebox where the cool packs are changed twice a day. At changeover the maternity team huddles around each bed learning about each woman until rounds are finished. A morning meeting completes the handover which generally ends in handshakes.
Throughout the morning the midwife will continue a thorough examination of each patient. At times these examinations are interrupted by the arrival of a laboring woman. As is the case back home, women find different strategies to cope with labor.
Many are quite stoic, laying quietly on their bed until it is time for birth when they walk down the hall to our delivery room and climb up onto the table give birth. Others walk and walk during labor to strengthen contractions. Some are more vocal, singing the song of labor that is often heard in labor wards worldwide.
There are no machines or computers to monitor, record, and constantly beep out the baby’s heart rate. Labor progress is recorded every few hours listening to the baby’s heartbeat with a hand held Doppler or a small tin cone which amplifies the soft thud, thud, thud of a heart inside the womb.
It is rare to accelerate labor with medication such as oxytocin. With time, most babies make their way into the world on their own. Agok Hospital is lucky to have one general surgeon who is skilled at cesarean sections if it is required.
Women are generally seen for prenatal care four times during their pregnancy. Ultrasounds are not regularly available and estimated due dates simply based on a woman’s last cycle can vary widely. Babies are usually small around four-five pounds. The average weight of a baby born in the USA is seven and a half pounds, when the rare baby of this size comes along she looks enormous.
Gestational age can be hard to determine at times, making preterm babies difficult to diagnose until they are born. Sometimes even the number of babies can be a surprise when suspected twins have been known to reveal themselves as actual triplets.
Large or small, these little ones are heartbreakers all the same. Although I try to remain unbiased when it comes to baby cuteness, I recently grew especially fond of a newborn after her mother told me she chose the name Mara-Achai for her little girl.
Lunch is taken when there’s a lull in the maternal action. In the blistering afternoon usually there are meetings to attend. Topics for meetings may include how to improve hygiene in the hospital, the danger of snake bites, or best strategies in screening and treating malaria. Often it is an expat staff member who provides an informative lecture or training, other times experts from our headquarters in Geneva travel to the field to provide insight and support.
Mostly I find the meetings interesting and helpful to hear how other departments are handling challenges like team morale, blanket shortages, or creative ways to improve patient care. One example is the latest hygiene posters encouraging employees, patients, and visitors not to spit on the floors and in general.
The snake bite lecture with its plentiful photos of beady-eyed snakes, the mechanisms of their deadly venom, and the graphic aftermath of victims was not one of my most enjoyable lectures. I did not know there is a snake that can spit its venom into a person’s eyes.
A short time after this particular lecture, we had a snake visitor slithering into the Maternity building. I was told snakes here in South Sudan like to follow pregnant women, especially those carrying twins.
The snake was pummeled to death by bystanders using stones. Later, an expert group including Dr. Ali, Nurse Johanna, and the bravest Midwife Assistant in Agok: Zahara, gathered to try to identify the dead serpent based on photos from the aforementioned PowerPoint. We think it may have been a black mamba, however the violent killing strategy with all the rocks had been so effective it was difficult to tell if indeed the snake’s mouth was a black color.
Snake identification team
The hottest part of the day is mid-afternoon when the sun bakes the flat dry land, bouncing off the metal roofs through the dusty haze.
The mothers and babies pass the afternoon sleeping and chatting with their neighbors. I feel my body slowing down what was once a brisk walk in the morning is now close to a shuffle. My brain too feels the effects of this sauna, I think mental math and good posture must be the first to go during the brain’s melting phase.
Work ends at 6pm, handover once again takes place for the on-coming night shift. Patients are discussed and care is transferred to the fresh team to keep watch throughout the night. Often during the night I carry a walkie talkie just in case the midwife working needs back up or a consult.
Walking back to the compound the day is winding down for everyone. Cold showers wash off the dust from the day before a dinner shared with colleagues and talk of the day.
Sometimes before bed there might be a group movie shown on a borrowed projector. Other nights the card games last late into the night. Back under my mosquito net the buzz and crackle of my walkie talkie, and visions of vipers taunt my sleep until the sun rises once again over Agok.