Night Guard at the Maternity Ward
10/11 July 2006

Last night my colleague Alli Bicki (age 17!) and I took a night guard shift at the Clinique Sikoroni, where GAIA is doing our PMTCT work. Arriving in the early evening, we spoke with the Matrons, Animata and Mariam, about their work, about birth in Mali and the difficulties encountered when a birth goes awry. If a woman is in need of a cesarean she must find the cab fare to get downtown to Gabriel Tourre or way up to Pointe G -- at least two to four dollars, a massive sum of money around here.

We also discussed the issue of Sorcery, and the difficulties of the Evil Eye. Women wear strings of myrrh around their waists to both fend off ill will when pregnant, to prevent or support pregnancy and to protect the womb in general. Babies are given bracelets of white beads with a kowre shell in the middle to wear on their right wrist, and their own strand of belly beads as soon as they can after their birth. One must not compliment the baby in any way before it is named, which on their one week birthday, lest Evil be drawn to the babe.

Waiting patiently for birthing women to arrive, we wandered over to the Medical side of the clinic, where we met two young doctors who had just finished school, and were excited about their ER duties. Donning white coats and stethescopes, we entered the exam room, where we found a boy of 20 months, lying silently on the desk cum surgical table. A male nurse, sans gloves, was performing a circumcision while the boy's father held his legs. The boy made no noise and lay perfectly still while a less than sharp tool was used to cut a circle of skin from his tiny body. Perplexed by his lack of blood curdling screams I asked about anesthetics. The nurse informed me that the family could not afford neither pain medicine nor gloves for the procedure, and that the boy was "Taking the pain like a strong African man." Ya right. Faining some need to check his breathing and heart rate, I leaned in close, armed with my trusty Littman scope, nose at the ready, and.... ah, the crisp smell of cheap booze on the breath of an infant. What poverty won't lead people to do...

After procuring gloves from the dispensary - GAIA donated over 70 KILOS of latex gloves this summer alone - I handed them to the attending clinician, and meandered back to the Woman-Side of the clinic. There is rarely a man seen on the maternity side of the courtyard, save the rare husband or father. Women birth alone, without their partner or any familial support. They make little to no noise, and birth without any analgesics of any sort.

At 1 am I was awoken by Aminata - un femme a arrivé! Moving across the courtyard, the moon was full and bright overhead lighting my way to the Sale de Accouchment. Therein, I found Sira, a Bambara woman in the throws of labor. She advanced quickly and quietly, enduring repeat vaginal exams without lubrication, and contractions with barely a moan. I cooed to her in my limited Bambara, and massaged her belly and shoulders, encouraging her to push. All of the sudden the baby crowned, and then I had cause to gasp aloud - the cord was birthing with the baby. The Matron looked up and caught my eye, and I moved down to the end of the bed, taking hold of the bed. With the next push, we found the cord wrapped snugly twice around the baby's neck, and she was cyanotic (blue) from lack of oxygen. As I pushed with one hand on the emptying belly and encouraged Sira to poussée, the skilled Matron pulled the baby out and quickly turned her around in the air, one hand firmly grasping her legs, one arm spinning her silent, tiny body to remove the oxygen-depriving cord from around her neck. Task complete, Mariam placed the baby with a thud on her mother's stomach and began to suction her nose and mouth as I began gentle sternal rubs to encourage the baby to breath. After a few tense seconds, which felt lightyears longer, she opened her little mouth and gave out a scream -- the most beautiful scream I have ever had the pleasure of hearing.

With her child breathing aloud, Sira closed her eyes and melted into the bed, and the plastic garbage bag beneath her which served as a catch all for the messiness of birth. While the matron took the baby across the room to be weighed, I helped Sira birth the placenta, which was, thankfully, all present (retention of placenta can lead, quite quickly, to infection). As soon as she was free of labor duties, Sira stood up, and walked out of the birth room into the room of bed adjoining it. I have never seen a woman get up and walk away after a birth as fast as in Mali. In the U.S. a woman will rest in bed for hours, and in Mexico they were kept on the table to rest for at least ten to fifteen minutes. But not Malian women at Sikoroni, they are up and away as fast as possible. Given the decrepit state of the birth room, one can certainly understand why one would want to flee it toute suite, though it does strike me as remarkable who strong these women are...

The rest of the night went well, no further complication, little sleep for the weary Matrons and tubabu visitors. The morning was went with strong café full of sweetened condensed milk, and tiny balls of fried millet. Eating voraciously, I couldn't help but sigh, and think about how amazingly lucky I am to get to bear witness to someone's first birth, someone's first breath of air, the start of a new and sacred life... to sleep, and tonight, to the clinic autre fois!