Saturday, September 29, 2012

Pinayanga (part two) ~

(Continued from previous post, read first.)

While we waited, Anthony (the untrained medical worker assigned to the post) gathered the mayor’s secretary, who called the mayor, who invited a few more friends. Then someone also sent for the traditional birth attendant who lived down the hill.

Word got out about our visit and several more gathered to hear what the foreigners had to say. All the officials sat on a wooden bench while we stood to address them. Roy spoke of our desire to train midwives, asking if they needed help in this area.

They nodded gravely and explained the troubles they had in reaching town when sick.
“The roads are bad,” they explained, adding that it was too difficult for their pregnant women to get prenatal care. “It’s too expensive to go into town for visits... and for the birth.”
-- “Do they deliver in the hospital sometimes or only at home?” I asked.
-- “Most deliver at home... but when they try to go to the hospital often our women deliver on the road.”
-- “On the road? Really?” I asked pretending surprise. “What do you do then?”
-- “Well... the baby comes and then we take them home.”

About this time, the traditional birth attendant arrived. Her name was Louisa Josepha and she wore a fade patch of fabric on her head, and another equally faded apron around her waist.

Bent slightly as she walked, she took the time to shake each person’s hand in greeting then sat down next to the mayor on the bench.

-- “Thank you so much for coming,” I said, greeting her through my translator Tucha, one of the orphans at the compound and the only one in our group that spoke her language. “I’m happy to meet another midwife.”

She smiled kindly in response, hiding the confusion and interest wrestling under the surface of her face. I could see she was flattered to be among the gathered, but she didn’t seem to understand why. So I started to explain.
The Mayor, Luisa and other towns officials that came to listen.
-- “Ma’m Louisa, I’m trying to learn about your needs as a midwife in the village. Can you tell me... are you the only midwife here?”
-- “Yes,” translated Tucha in Chitchetwe the local language since Louisa did not speak any Portuguese.
-- “Do you have an apprentice at all? Anyone you are training to help you?” I continued on. Everyone waited in interested silence while she responded. Every face turned her direction.

She explained that she did not have an apprentice and often she was too busy to care for the women who called on her. “My legs are weak now. When I’m called to the village 30 kilometers down the road... my feet hurt when I arrive.”
-- “You have to walk 30 kilometers to deliver babies?” I asked in naive disbelief.

At this point the mayor and all the rest of the men piped up to answer for her. They all spoke at once, gesturing this way and that, talking over one another in their desire to elaborate.

Tucha laughed because she didn’t know how to translate anymore; and decided to sum things up with; “There are many villages near by... and she is the only midwife. When called for help, she must walk there. One village is 30 kilometers away that way,” she explained pointing to her right. “The other villagers are 35 kilometers or so that way,” she pointed to her left and smiled. 

Once voices had settled, Louisa continued on; “I walk so slow these days...often I get there too late to catch the baby.”
I nodded that I understood. She was clearly no longer a spring chicken. When I asked her age, she just laughed and shrugged her shoulders as if I’d just asked her to calculate the circumference of the moon.

And we all laughed together happily, then I changed the subject slightly.
-- “Please tell me about your training... are you are nurse?” I asked hopefully.
-- “No.”
-- “Did you get the government midwife training at least?”
-- “Yes. Yes.”
-- “How long is that training? Is it weeks or months?
-- “It is 3 weeks long.”
-- “And does the government give you supplies... like gloves or medicines?” I asked remembering a conversation I had the week before. Roy had taken me to the town of Inchope and we spoke to the town chief and interviewed a nurse at the local clinic. He had explained that the government often paid a small salary and provided basic medicines to traditional birth attendants (TBAs). I wanted to see if that was the case for this village.

But once my question was translated, the crowd exploded again in excited chatter. Everyone had something to say but nearly all of them where shaking their heads. So it wasn’t a surprise when Tucha translated a quite, “No” and then looked at her feet.

-- “How many babies do you deliver a month?” I inquired. She looked put on the spot, so I rephrased it. “I mean... how many a week?”
That question she could answer.
-- “I have two to three babies born each week, or about 10-12 a month,” she explained.
-- “And you do that without any supplies...? Or gloves...? Or razors...?” I prodded.
-- “Yes. I have nothing but these,” she responded, lifting her wrinkled hands for inspection.

Satisfied that I had at least an idea of what I was dealing with, I decided to explain why we had come. “Please let me tell you why I’m asking you all these questions,” I started.

They sat a bit straighter and turned their ears my way in attention while I spoke.
-- “I would like to help the women of your village stay alive in birth. You have seen some women die after having babies here, haven’t you?” I asked presumptuously informed. (The latest statistics place Mozambique in the world’s twenty deadliest country in which to give birth. In Mozambique one out of every 37 women will die in childbirth over her lifetime.)

They nodded uncertainly, but as I explained that women are dying all over Mozambique in childbirth and not just in Pinayanga, they looked less stressed to admit so.
-- “Yes. Our women have died in childbirth,” confessed the mayor gravely.

I acknowledged his words with a slight nod, them moved on.

“But I am also interested in helping your babies stay alive...” I continued on with translation. “What I’d like to do is come to your village each month to help your women get prenatal care, then also take some of your young students to train to be midwives.”

As I detailed the idea and discussed the kind of student I was looking for, they started getting noticeably excited.

-- “But if I train one of your young ladies to take care of your wives and children then you have to build her a clinic to work in. And you have to pay her for her services.”
-- “Yes. Yes,” they broke out in excited chatter. Then while pointing to the building in which we stood they added, “we built this ‘Posto de Secorro’ for Anthony with bricks we made by hand.”
The pride in their voices was unmistakable; I couldn’t help but smile.

The conversation went on like this for some time. I’d ask questions, they’d propose options. They’d ask questions and I’d outline what I had in mind.

By the end of the initial meeting, they asked me how many of their young ladies I was willing to train.
I turned to Roy for help but he just laughed. Finally, I confessed, “To be honest, I was only thinking about training one or two from this village.”
-- “But this village is the hub for nine other villages. Can’t you train a midwife for each of those villages too?”

I smiled deeply at this mayor’s farsightedness. Clearly in his mind, one midwife just wouldn’t cut it. He needed ten.

I stopped and prayed softly under my breath before answering. Lord, I would love to be able to train ten midwives for this area. Please do this and much much more. For Your glory and for Your name sake. Amen.

I smiled and said, “Let’s start with two... and then go from there.”

The Mayor nodded enthusiastically, then asked, “So when do we start? This month?”

Maria and Tucha -my translators.
You should have seen the grin on my face as we drove home that day. When I turned to Roy, he was grinning too. Even Tucha and Maria (the other orphan who came to translate that day) were giddy with excitement. They were thrilled to see how positive the villagers responded to the idea.

All four of us rode home grinning.

Even though the Ministry of Health was still (at least at this point) unwilling to talk, at least we knew that the villagers were positive about the concept.

The door was starting to give way... would it open?

More of my story to come.... sorry it has taken me so long to write. I’m blessed to be so busy these days that I have no time to write all I’m doing and thinking. But I promise to try and catch everyone up.