I’m finally back. Computer charging issues,
internet connection issues and labor and birth issues all kept me isolated and
unaware in my little house at the edge of the village. I have noticed in my
time away, with only the briefest stolen moments visiting the cyber cafe, that
already my fingers have learned a new keyboard and it is with some effort that
I now revert to my original settings (happily, magically the j,k,l keys have
been restored and are in working order.)
I am back with stories, they’ve been
building up over the weeks and I guess the best place to begin is with the
primary reason I was away. My birth story, or rather, the little princess’
birth story is, of course, not like others. Nothing I do is ever easy or straightforward
it seems and giving birth is no exception. The little sweetie arrived in true
African style- lots of drama and fanfare to bring her into the world.
We don’t have a new age story of a water
birth or a contemporary account including a midwife or a doula. There is no
amazing home birth tale and happily no tragedy to report. But there is a story-
our story of one birth in Abidjan and it begins somewhere in the middle, as I
am fond of stories that get right down to the essence of things.
PART
I- Fevered Negotiations
Christian reached over to pick up the white
sheet of paper lying on the tray, a sheet of paper I would have left behind,
blank and untouched. He gave it his careful consideration, reading each
question, checking off boxes and nodding his head in satisfaction. “What do you
think? It’s good not to discourage anyone.”
He handed the paper to me for review.
He’d marked a variety of “satisfied” and “very satisfied” on the
hospital survey sheet. I looked at him incredulously, smiled faintly and wondered
if we’d spent the last 3 days in the same place.
We’d arrived at the Polyclinique on a
Saturday afternoon. The Thursday just
before I had shown up with a slight fever and some contractions. I received a
fever reducer, monitored the baby’s heartbeat and elected to go home once I
began feeling better. The next day I felt so completely returned to normal that
I was happy we had evaded the hospitalization and c-section that had been talked about on Thursday. We had gotten the happy news that the baby had turned
herself around and was in good position for a natural birth. We were determined
to stick to that happy path.
On Saturday morning I headed out to see the
boys' soccer game at the camp by the lagoon. An hour into the game, the cool
breeze coming off the water had me shaking visibly and uncontrollably. A pile of covers and my cozy bed was calling
me. I moved, not quickly, but with
focus and managed to grab a taxi home.
My temperature had plummeted to 34° and my
fingers were blue. I breezed past
Christian’s alarmed face and dove beneath the blankets. Within 15 minutes my temperature rose to 37°
and by the time we arrived at the hospital I was near 40°, sweat pouring out of
me like a cartoon character and contractions coming strong enough to make my
eyes water. The doctor had agreed to
meet us this time and so we sat in the waiting area hoping for her quick
arrival.
She called us into an available office where
she confirmed my temperature. She wanted a malaria test. I’d already had 2
malaria tests in the past 3 days- all negative. She began to speak again of
admission to the hospital and a c-section. We’d been trying to avoid this. My
main issue was not really being able to determine if I was in an emergency
situation or not. And whether or not I
actually had malaria (remembering, of course, that it’s always malaria, even
when it’s not.) The doctor had appeared to be pro-caesarean in the short time
we’d known her and that was essentially the problem. We just hadn’t been here
long enough to make a real connection, to develop the necessary trust and to
really delve into her philosophy of childbirth.
Christian was really pushing to avoid the surgery and the doctor hadn’t
convinced me yet. But I was dehydrated
and feverish and wanted attention. I admit to yelling a bit at this point. Yelling about the malaria test, yelling that I wish I could just trust the doctor's decision and not have to try and make it myself. I reflected- loudly- that perhaps going to the US would have been a better decision, even though I knew I didn't really mean it. Not for the months and months. But for just this one moment, this one health care moment, the US would have been a bit more comforting.
Meanwhile, Christian began the negotiations
on price. Because the hospital did not take my insurance, I’d had to complete a
bunch of paper work and pre-authorization forms in order to be sure I would get
reimbursed. This included the cost of the hospital, doctor and medicines.
Often, hospitals in Africa require the patient buy all the medicines separately
(usually, conveniently, at a pharmacy located within the hospital) in order to
be treated. The doctor or nurse needs to receive the receipt of payment before
issuing any medicine. We’d had numerous conversations trying to determine total
cost and had been assured the fee sheet they’d given us was all- inclusive
(doctor, medicine, room, even meals.) Now that we were being faced with
possible admittance to the hospital, the game was changing. We worried that if
the fees were suddenly higher than those we submitted, we wouldn’t get
reimbursed.
While I was on the phone with insurance
company getting the ok to be admitted and possibly receive an emergency c-section,
Christian was busy negotiating the fees for the hospital stay. It sounded like he wanted even less than had been written on the fee sheet. Or maybe that's just the way negotiations begin- much lower than the final price you hope to end up at. And me? I was still dehydrated, fevered, drenched in
sweat and contracting. I’d like to think
the part when Christian began suggesting we go hospital shopping for a
different place that would accept my insurance outright (not possible I tried
to assure him) or one that was less expensive
- yes, I like to think that whole conversation was part of a fever
induced hallucination. Go out into the world, searching for clinics? In my
state of half labor and half delirium?
Had he any idea how much scanning and emailing I had done just to get
the clearance to deliver here, in this hospital?? Or was this just harmless
threatening, all part of the bargaining process? Like, these apples aren’t that
good for the high price you’re demanding so I am going to buy from that guy
over there……and then hoping the response is No, no, no of course I will reduce
my price for you.
Except we weren’t buying apples. And I didn’t really want to negotiate. What I
really wanted was some of that saline or glucose drip they give to people who
are dehydrated. Every sip of water I had tried to drink came back up almost
immediately and I’d been reduced to sucking on ice. We had been at the hospital
for what felt like an hour – without ice- and all I wanted was a drink. I tried asking for that thing- yes, my French failed me miserably in the hospital, not
having any of the needed vocabulary- you know, that thing, I said, you give to people who are full of thirst? Can’t I
get some of that?
What I finally managed to get was moved
upstairs. Christian and the doctor had agreed to begin treating the fever. We’d
also discussed a c-section. I was trying to be convinced it was an emergency.
It was feeling that way as more and more time went by with no one actually
doing anything. The doctor kept saying,".....and you can check the internet on that." The 21st century version of 'trust me' I guess. The problem was I couldn't search the internet on that. Not easily anyway. I had tried looking for 'fever' and '37 weeks' but nothing helpful came up. And the site I really wanted was nowhere to be found. The one that said, "Yes, it's an emergency Soumah, you need the surgery. Go ahead and trust your doctor. Yes, you." In the end, what else could I do?
In the maternity section, I was greeted by
several of the nurses from the previous visit.
But still no one really took action. Somehow it appeared that the
negotiations weren’t really over. Christian began talking about treating the
fever and going home again. The nurses wouldn’t begin any treatment until he
went down to admissions and paid something. It was the amount of the
‘something’ that was up for debate.
I had tried to work with him in the months
before this moment, prepping him on how to support me during childbirth. I
hadn’t run across any Lamaze classes or other childbirth prep and so tried to
give him some pointers on how to best be my coach. He’d already succeeded in
staying with me long past the moment when the nurses tried to kick him out.
That part was good. But at this moment,
still arguing over costs and procedures- and it was getting heated- I kicked
him out. Just go, I’d said while using my pagne to clear the rivers of sweat
streaming down my face. I was ready to start throwing cash at the nurses in
order to get some attention. “Don’t you even take the blood pressure?” I asked,
feeling hopelessly lost and nearly invisible. Hello, it’s me the patient. I
have money and I want help.
This was enough to get things rolling- or
perhaps the negotiations finally finished. I was completely out of the loop on
how those things were progressing. The raised voices quieted, laughter actually
ensued as Christian went off somewhere to pay some agreed upon advance and the
nurse finally took my blood pressure.
The fetal heart monitor was put in place and I saw my little girl was
racing at just over 200 beats per minute.
Christian soon returned, began fanning me and reminding me to breathe,
all those coaching lessons finally coming out. After an internal exam, the
doctor began muttering about how ‘sensitive’ I was. “Just a touch and you start
bleeding. There is no blood in Abidjan.” She repeated this last line several
times, shaking her head to emphasize her worry over my likelihood of
hemorrhaging. It was both exactly the kind of thing I didn’t want to hear and
the kind of thing to convince me. The nurses began prepping me for surgery and
from that point, most things returned to the normal world of doctors and patients,
sick people healing and babies being born.
PART
II- La Gaaz and les sage femmes
