dawn: adventures of a journeywoman

A shot of dancers performing a traditional dance from the coast of Kenya during a performance I attended during a day trip to Nairobi last weekend.

“Pumua kwangufu.” Every day I seek to learn a new useful Swahili phrase. A favorite by many is pole, pole, or slowly by slowly; which is just the pace that my Swahili skills are coming. “Pumua kwangufu.” Breathe deeply, or take a deep breath. That phrase has proved useful in many ways and in a variety of circumstances this week.

I have now spent a week in the obstetrics and gynecology service. Having officially applied to receive residency training in this field just yesterday, I have been looking forward to rotating through this service. I have been saying, “pumua kwangufu” to several expectant mothers while letting them squeeze my hand as they manage contractions without pain medicines. In the bed across from them is a Somali patient awaiting a blood transfusion after five days of constant bleeding and loss of fluid (ruptured membranes). Her baby is miraculously still alive, but much too young too breathe on its own if delivered. So she patiently endures my daily pantomimes with a smile when no interpreters can be found. (I must say, the way I act out “Are you having palpitations?” or “Is your baby still playing/moving” are not to be missed).

I have been able to be first assistant on several caesarean sections. “Pumua kwangufu,” I instruct each mother as I hold her shoulders during the placement of spinal anesthesia. One mother last week had a C-section as her fourth delivery. She had yet to have a child survive their first hours of life, as her first three were either stillbirths or nearly so from complications of pre-eclampsia (hypertension/high blood pressure in pregnancy). As I pressed on the abdomen to assist in the delivery, the mother heard a sound quite new to her-a cry signaling her child’s first breath. I exhaled a sigh of relief and thanked God for the opportunity to be a part of offering this mother such a longed-for gift, the fresh breath of a new life.

Yet not all pregnancies are so joyful. Another Somali patient I am caring for wears a burka and a wedding ring. But four years ago as a teen, she remained in labor for seven days before being taken to a health facility. By that time, the baby had died and the pressure had created a large hole, or fistula. Her constant leakage of urine made her an unsuitable wife and her husband promptly left her. Her brother and a friend boldly chose to support her and help her obtain the necessary surgery to correct this anomaly, unfortunately common in many areas of sub-Saharan Africa. Fistulas arise from many causes-young mothers carrying babies beyond the size they are able to accommodate, circumcision scars that do not always allow for birth, inaccessibility of caesarean sections when needed, and unwillingness of family members to promptly seek out further medical treatment for a laboring woman (who as one man famously put it when asked why paying for his wive’s medical expenses was not a priority said, “I can always replace my wife if she dies, but it not as easy to replace my cow.”) As I observed this patient undergoing her third difficult surgery to correct this fistula, I found myself praying for wisdom for the surgeons and holding my breath that this surgery would be her last.

Another woman was brought in last week from Kibera, the largest slums in Nairobi. I took deep breaths in my mouth to avoid the cloud of unpleasant odor. A benign uterine tumor had grown and decayed long ago, leaving her uncomfortable and shunned. I watched the Ob-gyn seek to find a way to finance a surgery that was well beyond the means of one who found it difficult to feed herself and her children.

“Pumua kwangufu,” I tell myself. Yes, life this week has been exhilierating and hard. But being aware of my own breathing reminds me that I am still blessed with the gift of life. It also reminds me that I don’t know how many more inhalations and exhalations I have left, but I do know what I am to do with the breaths I have. “From life’s first cry to final breath”…“let everything that has breath praise the Lord!”