Claire
Here in Tanzania, one thing we have learned is that no matter how well structured, well thought out and planned our day is, things don’t follow a schedule or a predictable pattern. The more you push, the more it resists.
Last night, after a sunset walk up Ngangu hill and a casual dinner, Isabelle, Rachel and I were just settling in to our evening routine of pyjamas and a game of cards around the table. We had just started to halfheartedly play yet another game of gin rummy while yawning sleepily, when our night took an unexpected turn; Dr. Victor Kyaruzi, our friend living in the visitor centre with us and a visiting doctor at Kilema Hospital, burst through the door at 8:15 PM with an excited grin on his face. Standing in the doorway, obviously in a hurry, he enthusiastically announced that he was about to preform a C-section surgery, and we should all join him to watch! It was something we had earlier expressed interest in seeing, when the possibility of it actually happening didn’t seem nearly quite as real. Surprised and eager, the three of us jumped to our feet, leaving our once preciously held cards in a forgotten mess splayed over the table top as we scrambled and scurried to gather our sandals and head out the door. We headed into the warm night on our way to the operating theatre, less than a minute’s walk away, wondering what was to come.
Steve
“Will these fit you?” asked Dr. Victor, referring to a pair of Women’s size 9 rubber boots that I was going to have to wear in the operating theatre during the emergency caesaren section I was about to assist him with. I shrugged and then crammed my size 13 feet into them, appreciating the pain that a young Chinese girl from a bygone era must have felt having her feet bound. Draped in a surgical gown that could easily be worn as a warm layer on a cold winter day and nearly immobile in my boots, I felt even more trapped than when packed into a dalla dalla-the local Toyota minibus not bigger than a minivan, which in North America would be configured to accommodate maybe 10 passengers, but here it is setup for 20 yet is routinely packed with 25 people! Sweating like in a sauna I was afraid I would perspire into the young woman’s abdomen, but I was overjoyed to share this experience with Claire, Isabelle, and Rachel, knowing it would have a powerful effect on them.
Rachel
We donned the worn, light-blue scrubs, scrubs caps, white rain boots, and child-sized face masks covered in Disney characters. After a brief wait, which Victor lamented, hoping it would not lead to any complications, my dad and Victor scrubbed in. The young soon-to-be mother was wheeled in and prepped. Now in the OR, as the general anaesthetic (ketamine) was administered to the 17-year old mother, the doctors and nurses uttered a comforting, traditional prayer. This striking moment is recalled differently by each of us: Claire tells me later she found this prayer calming and reassuring; in the moment, I think I found it somewhat more unnerving, as if the doctors and nurses were calling on some higher power to keep the mother and baby safe, in the absence of high-tech medical equipment and a surplus of supplies.
A baby girl was born that night, and we saw the whole thing.
With my dad assisting (and looking, really, just like my regular old dad, me baffled that he was in fact assisting in this delivery, in Tanzania, Africa, at 9 o’clock at night when he’d been lying in bed only 20 minutes before…), Dr. Kyaruzi made a long incision into the young woman’s large, stretch mark-streaked abdomen, her dark skin separating to reveal white fat, lots of blood. Down he cut through the layers of fascia and muscle, both he and Dr. Steve reaching their hands in, pulling outwards with great force to widen the opening and expose the purple uterus.
A cut is made, fluid and blood gushes; the amniotic sac has been broken. Suddenly, a dark head of hair is exposed! Victor urges my dad to push on the woman’s abdomen, push harder, to help force the baby out. The head is large. It’s taking too long, we all think. Why isn’t the head coming out? Isabelle, Claire and I hold our breath, I clasp my hands in front of my face. Finally, after much tension and pushing and pulling and silent prayer, the big, dark, curly head is freed. In a flurry of hands and pulling, the shoulders and body are swiftly delivered; this small life is brought into the world. Collectively, we girls gasp.
All I can think is, the baby is so blue…it’s not supposed to be that colour. The umbilicus is cut, though I don’t recall seeing it; the baby is whisked over to the back of the OR to a small metal tray. “So, it’s a girl?” Isabelle says. In the action I didn’t even hear the nurse announce this, but she did. A baby girl.
It is too silent; no crying yet fills our attentive ears. We 3 girls walk over to the baby, concerned, while Victor and Steve remain entirely focused on the mother, entirely professional. An ambu bag is brought over, the baby is bagged and her tiny lungs are pumped by the anaesthesiologist. The nurse and anaesthetist take turns flicking, smacking, and poking the baby girl, urging her to cry or cough or breathe. She is so pale, so grey-blue. A vial of adrenaline is grabbed from a nearby cupboard and injected into her tiny left thigh. Slowly, amid the manual breaths, she appears to start moving her mouth. “She’s coughing!” Isabelle and I quietly exclaim in unison. Just a tiny little bit, but it’s something, enough to relieve us.
A nurse then takes the baby into the recovery room right beside the main operating theatre, and places her under a warm lamp. Praying, lifting, smacking, and jabbing ensue for many minutes; her cries are weak, slow, and intermittent. “Why are you crying like that, so slow?” the nurse asks the tiny human. The general anaesthesia has affected her, it seems. I keep thinking, there are no machines, no tubes, no medicines; would it be like this at home, in North America, if a baby were this slow, not yet pink?
I return to the main OR to the mother’s surgery, and through the window see the baby, wrapped in a colourful kitenge (a traditional colourful Afrcican fabric) carried away in the nurse’s arms to the maternity ward (though I thought, perhaps, she was being taken to a priest to be baptized, so she would go to heaven…still not convinced she was crying nearly enough, still so pale and bluish).
The young mother is waking up, moaning, her ketamine anaesthetic wearing off; but her abdomen is still wide open. The uterus is being stitched up; my dad points out the Fallopian tubes – how cool! A real live anatomy lesson. She groans louder. Finally the anaesthetist gives her another dose. All the layers are stitched up, Dr. Steve given the honour of the final step, suturing her skin closed with interrupted sutures. Mama is cleaned and wiped up, her wound dressed with an adhesive bandage that has been carried across the globe from Canada in a duffel bag. Her legs writhe as she slowly begins to wake again. Mama is okay, the baby girl is well, too (she must be, right? But we are still not certain).
Isabelle
The experience, an unexpected and welcomed one, feels entirely like a dream come true. We were all keen to witness a c-section, but uncertain of the reality of this taking place. Although we eagerly told Dr. Victor (here the doctors appear to go by their first name although this could be just for us) that he could wake us at night if one was to occur, it seemed unlikely that he would think of us at 3, 4, or 5 AM when he was focused on helping a mother bring her baby into this world. To our surprise, a c-section occurred on Friday evening around 9 PM, shortly after our discussions with Dr. Victor. The first thing he did was to come gather his mzungu friends.
I was surprised at how calm Dr. Victor was, but later realized this was due to his experience, and likely his desensitization at seeing surgeries. My heart was racing as if watching an action film. So many thoughts ran through my head. Was I really about to witness a child being pulled from her mother’s abdomen? Would I be able to watch the whole thing? How much blood was there going to be? As most people close to me know, I have had an aching fear of needles and blood for some time. Naturally, my curiosity, as it always does, took over in this situation and I hoped that regardless of both phobias being very present for the surgery, I would brave the experience. I did in fact make it through not just the c-section, but Rachel and I were the ‘flashlight shiners’ for a second unexpected surgery after the c-section was completed by Dr. Victor and Dr. Steve.
Just as I caught my breath, having learned from a nurse that the newborn baby girl was in fact stable and pink in the maternity ward (yay, what a relief), I watched Dr. Victor write the operative report about the c-section. Suddenly, we heard shrieks and uncontrollable sobbing from outside the OR. I poked my head out into the cool night air, finding a young woman with bloody gashes all over her face. The nurse led her into a different, smaller operating room, informing us that this young woman had fallen off a piki piki (motorbike), one of the most unfortunately common and terrible accidents in Tanzania. As she was lying on the table, shivering in shock, we examined her closer. Her face was so swollen, squished together like a new born baby (mtoto) unable to open its eyes for the first time. We were all murmuring, “Pole sana” (very sorry) over and over. Through her pain and swollen lips she uttered back the traditional reply, “Asante sana” (thank you very much). I lightly chuckled that she would take the time to respond while in such pain. Not a ‘haha’ laugh, but a surprised one at her graciousness in this time of pain. Our hearts, for the second time that evening (the first when the newborn was blue, barely breathing) nearly stopped beating, and our eyebrows furrowed with concern. Her face was so torn up: a hole pierced her chin, a large hole below her nose and on her eyebrow, amongst many other cuts.
As Dr. Victor and Dr. Steve, a team appearing to have worked alongside one another for years, began to stitch the woman’s face up, Steve exclaimed, “What poor lighting!” Agreeing, I asked about the possibility of taking my iPhone out and received an excited “ndio” (yes) from the team. Rachel was handed a flashlight, while I held my phone, and we shone them over her face to provide illumination; our contribution to the procedure. Another moment to chuckle at the un-Western situation.
Steve
Unfortunately, here, access to morphine is restricted to palliative care patients, so her only relief came from local anesthetic. But she was still remarkably appreciative of the care she received. I was surprised that not only did neither Rachel or Isabelle faint while illuminating the surgical field, but that they were so eager to watch!
Isabelle
We watched as every last stitch went into her torn up face, the gashes becoming x’s of thread while silent tears continued to slide down the side of her face.
