A Birth Story - in 3 parts

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 

How I lost my faith and got it back again...for now

It's the eve of the boys grand departure- their first flight solo- and Mohamed has been sick for nearly a week.  He shares my great dislike of doctors which makes getting him healthy an even bigger challenge than might normally be the case. Of course, sickness in Congo is always a challenge.

When it comes to myself, I am quite happy to self-diagnose, self-medicate and travel through the journey of trying to figure out exactly what it is that ails me. It's a bit easier since I am able to feel the slight aches and pains and have some experience with my body. We know each other well. It's a lot harder to self-diagnose someone who isn't yourself. And if he is only 10, he's probably got a lot less experience with knowing not only what hurts and where, but how it hurts.

And if you happen to be that normally healthy, energetic 10 year old's mother, it's a lot harder to be objective and patient. But we do have a routine for dealing with sickness. It always begins with a trip to "clinic A" for a malaria test. Clinic A is helpful because they have a speedy, reliable test. Or so I am convinced. Because of the impending travel (some 6,000 miles, alone, on an airplane!) I thought perhaps we should see the doctor- just to make sure we'd covered all the bases.

Clinic A is always overpacked and overbooked. A long wait is certain. The benefits for me include only the fact that all fees are billed directly to my job and so I don't have to lay out any cash. Extremely convenient. While we were waiting to see the doctor, I took it upon myself to go ahead upstairs to the lab and get the malaria test. An hour or so later, we were finally in to see someone. We sat in front of his massive desk as he asked a few questions and then wrote out prescriptions for a malaria drug and a fever reducer. We already had the fever reducer and we hadn't yet received the results of the test. No headache or other pains had me feeling suspicious about whether this was really malaria. Of course, if you're a frequent reader, you'll know that it's always malaria, even when it's not.

I remember being, perhaps eleven, or maybe even into my teens when I realized- somewhat incredulously- the doctor was only asking questions. That's it?! What if I lied? What if I was mistaken? It seemed the entire diagnosis hinged on my answers to the questions. The entire medical process took a huge downward tumble in my rank of reliability.

But then there was the time in my early twenties when I suffered a miscarriage. I was in the midst of agony emotionally and physically when a doctor walked into the emergency room. He was clad in leather and shook his long hair out as he removed his motorcycle helmet. My entire faith in the medical world was restored for a moment as he asked kind questions and gently reassured me that the world would go on and I would have plenty of happy, healthy children.

My experiences with doctors have continued to rise and fall in such a manner. Complete faith and gratitude, complete disappointment and confusion. When I was living in Florida and pregnant with my youngest, I went to the doctor regularly for all the suggested maternal and prenatal appointments. I was in a state of disillusionment with all things medical at the time. Things really reached a new level of complexity and confusion when I arrived in NY to give birth. I was 9 months pregnant and due any day. I visited my long time obstetrician and in a matter of minutes she was able to tell me the baby was "head up" and I would need a cesarean. All from listening to the heartbeat with a stethoscope. No fancy equipment needed. Of course, my faith in her skyrocketed while my bewilderment at what exactly the other doctor had been doing only added to my confusion.

And then there was the time in my thirties when, after battling depression since my early teenage years, I'd finally gotten enough courage (perhaps desperation) to ask for something. Medication. To help me over a very great hump. I was told by my primary caregiver, after a quick review of some major life changes,  that "I'd only brought it on myself, hadn't I?" My faith once again plummeted.

I have become expert at knowing my body and it's needs. I've moved to a nearly all year sunny and warm climate, exercise with addiction and use a variety of essential oils and natural remedies to keep myself in balance.

I generally employ these methods for my children as well. They run when I come with the mint oil for head and body aches. They struggle to gulp down strong ginger teas peppered with cloves for whatever ails the stomach. And in general, they stay healthy (the best way to avoid all of mom's natural cures.)

Try as he might, Mohamed couldn't fake his way into feeling better. Anytime he felt my hand on his head, checking the temperature, he would pop up with a momentary smile and say, "What? Yeah, I'm ok." After a day or two of this, however, he began to sadly admit when he felt the fever returning (as if his drooping eyelids weren't evidence enough.)

Just as we were leaving the clinic, we ran into the lab technician who managed a surprised, "You're still here? Ok, wait for me." We trudged back upstairs to get the results. Negative. Great. Really, not having malaria was a huge relief. Except we'd already seen the doctor, who'd already prescribed a bunch of medicine that we didn't really need. And that had taken more than 2 hours.

Now what? We went back home, he gulped down more ginger tea, echinacea, some effervescent fever reducer (could we get some children's tylenol in liquid here people?!) and hoped the morning would bring a miraculous recovery. Despite my suspicions and the negative malaria test, I gave him a dose of Coartem, figuring at worst it could prove as a prophylactic.

The next morning did not bring full recovery and with only days to go before the trip across the ocean, we set out for Clinic B. Clinic B is rather expensive- well, for Africa I suppose, where it is still possible to pay for all your medical needs out of pocket if you happen to have an ex-pat salary. I admit to spending the morning raving about the ineffectiveness of doctors in general and their inability to do more than just guess (a mother's stress and hysteria does make one prone to stereotypical generalizations of the unkindest sort.) Aside from Clinic B, however, my only other options were full scale hospitals. Mohamed is a terrible patient and even getting him out to the clinics is an effort in cleverness and charm ( ok, threats and bribery.)

Clinic B is usually full, but not overpacked. There's always a wait, but it's not unbearable. There is only one doctor and one examination room. It's clean and sterile and open. The doctor is white haired and friendly. We sat at his massive desk while he asked a few questions. Then he told Mohamed to take off his shirt and lay on the examination table (a step we never got to at Clinic A, I noticed.) Doctor B took his temperature (38.7!) attempted to do a fahrenheit translation for me (no need, I told him as I'm getting pretty good at Celsius however,) felt his stomach and then looked into his mouth.

Ah ha! It was there, looking into his mouth, that he diagnosis tonsillitis. Step two in my self- medication routine- when it gets down to needing prescription meds- is usually antibiotics. I'd been about to go there with Mohamed but really didn't want to chance anything before the long plane ride.

So there it was. Faith restored. With a gentle touch, a look, a human interaction, the doctor was able to allay my fears and return me to the land of normal motherhood. (oh the worries and nightmares grow proportionately with each day of undiagnosed ill health.)

Once again, a tale of two doctors, two approaches, two different results. I guess I am back to feeling gratefully in awe of the medical profession. For now.

Magic chalk

Just when I had vowed to get back to some kind of regular writing, I was attacked. It was a big nasty Congo sickness attack that pulled me under for more than a week. In fact, just now, I feel it threatening to come back again.

In general, I am a pretty healthy person. I try to eat well, exercise often and think naturally. But it seems one can't really avoid sickness altogether in Congo and of course the problem lies in the fact that getting sick in Kin is not something you can just ignore. Because it could be malaria, a dangerous amoeba, or just the flu. Or an amoeba from last time that you never quite got rid of.

A malaria test is pretty simple to get here and you can even buy a test-yourself-at-home kit in the pharmacy. I elected to run down to the corner clinic and get a quick pinprick. A follow up telephone call a few hours later  informed me that I tested negative for malaria. But my body was screaming out all kinds of fever and pain and nausea. I wasn't really convinced.

Africa has some very intense shots. I have had the "fever shot" twice now and it is a wonderfully powerful thing, even with my aversion to doctors and medicines. A friend of mine called his doctor friend who actually made a house call to me in what felt like the middle of the night. Come to think of it, the last time I had this fever shot, it was also by house call. I was in Kankan, Guinea at the time and something about the red dust there seems to render all visitors ill as part of the welcome package.

The nurse- who arrived with the doctor and a little silver tray filled with new syringes, medicines and a blood pressure cuff- took my vitals and shot my backside with the marvelous elixir. While my fever dissipated and I spent a night of good, deep sleep I wasn't really better at all the next day. My stomach was in a terrible state of dry heaving and nausea.  It no longer felt like malaria but a dreaded stomach virus.

I slept the entire day, being washed over with wave upon wave of dizziness every time I opened my eyes. I made a trip to the see the doctor at his clinic this time, and was promptly given an IV. Every sickness in Congo seems to require an IV and of course, its always malaria. Even when it's not. I tried to insist that I'd had the test and it was negative. I tried to insist that it just didn't feel like malaria, but I made little progress. Its always malaria. The tests themselves are often considered unreliable or uninformative- or so I've heard. I've always had good faith in the lab I go to.

However, I was given some quinine (by IV drip of course) which only increased my dry heaving. My friend who accompanied me fell into further shock and panic at watching my efforts to heave the empty contents of my stomach, and perhaps parts of my stomach itself, steadily increase. Eventually he convinced the nurse to take out the drip- the bag had nearly but not quite finished- and we made a hasty retreat back home.

The next morning I was feeling better- slowly better. I had resorted to eating small snacks like potato chips and crackers every hour to calm my stomach. As long as I did that, I was able to walk around and even go to work again. It went on that way for days- each day slowly improving while I munched my way through the entire junk snack section of the corner store.

But then the itching started. Perhaps a side effect of the quinine. There are always side effects. And the itching was so intense it woke me up one night at 1 am. I spent a delightful hour scratching my legs, my abdomen, my back, my arms. Just clawing like a cat and swept up in the pleasure, pain and surrealism of it all. I woke in the morning wondering if it hadn't been part of some bizarre dream. I could almost feel my tail twitching and the taste of fur in my mouth.

The itchiness went on for a few days, becoming more and more inconvenient. I'd begun to self medicate (another must for sickness in Congo) and had taken Zentel (in case of worms or bacteria) and a few antibiotics (in case of other stomach parasites or the dreaded amoeba). I stopped the antibiotics after only a few days because of other unpleasant side effects. (There's always side effects.) I'm not actually sure if the itchiness was related to the quinine, the amoxicillin, or something else altogether. My friend noticed the scratching and suggested a local medicine. (There's always a hidden local medicine that's bound to do the trick.)

It looked like this, but it's not this.....yeah. 

It came in the form of a yellow rock (I've searched everywhere for the name of this magic chalk, but I simply cannot find it.) The rock is crushed into a powder (it's only 300FC so you have to do your own crushing) and is safe enough to eat. "You can even eat this, super safe, super strong but wouldn't harm a baby," I'm told as he takes a nibble off the rock. I am immediately in love with all the paradoxes of this material, which is said to come directly from the Congo River itself.

The powder is mixed with oil- my friend insisted on the oil "that you cook with" but I eventually talked him into using some almond oil I have for mixing essential oils with. Seemed better for my skin. This chalky oil mixture is then rubbed all over the body, leaving, well, a chalky oily glaze on the skin. "Don't wash that off," he implored. The smell of this substance, not altogether pleasant, only slightly unpleasant was- of course- one side effect. The other was the satisfying sensation of rubbing oneself with a rough, course substance (which in itself might be related to any relief of the itchiness one is already feeling.)

I was then instructed to take a teaspoonful of the powder, swallowed with water and repeat the next day. I've been assured all itchy sensations will disappear. I have noticed a distinct reduction in my discomfort and feeling a lot more human like and less cat like for certain. Right now, I'm just waiting for some other side effect to show itself....or maybe the amoeba to wake up back up....