Monday, 25 March 2013

“That’s why they call it ‘labour’”

There is something magical about the birth of a baby. After nine months of getting used to the idea that a little person is growing inside the woman, the time comes that this human parasite is pushed out, in only seconds changing to a breathing and screaming little baby person, growing up to be a be unique individual human being. During my time as an intern at the obstetrics department in a hospital in the Netherlands, this moment was easily so special that it could bring me to tears, especially if the couple showed the some of that amazement, love, and explosive joy towards the new life (and yes, this is not always the case, being in shock is also an option for new parents...).

In the Netherlands the delivery rooms are equipped to make the delivery as personal and special as is possible in the setting of a hospital. In the private delivery rooms lights can be dimmed, there is a comfy chair for the husband, a personal warm shower or a skippy-ball for during the contractions, even a cd-player so that you can bring your own music for it all. The couple is attended by one midwife or nurse (if possible), and making the woman in labour comfortable is one of her/his main objectives. Of course delivery itself is by nature a painful and messy business and there is plenty of room for improvement when it comes to the hospital treatment for sure (and it also might all be different in other hospitals than the one I worked at), but over-all it is not too bad...

[As you can imagine the next part will be to describe the labour ward at the hospital I work at in Ghana, which can hardly be more different from what I described above. The only problem is, how do I do this without making it sound very horrible? If you look at it from your lazy chair in whatever country you are when reading this, it is so out of context that it might seem shocking, inhuman, and sometimes maybe even cruel. Which it is in some way, don’t get me wrong, but it also does make sense when you see the workload here, the shortage in staff, space, and equipment. So please take that in mind when continuing to read the next part...]

Now imagine being in labour and having to wait on a hard wooden bench with several other women in labour. No room for movement; if you try to walk around you get yelled at by the midwifes and immediately pushed back onto the bench. If you finally are examined by a doctor after a couple of hours, you get a slap and a sneer from the midwife if you’d forgotten to take off your underwear before you climb onto the high examination bed, which you first have to cover with your own plastic cover.

Without introduction the doctor starts vaginal examination (contraction or no-contraction). If you touch his arm in a reflex of a pain wave from a contraction combined with the painful examination there is a disgusted “DON’T TOUCH ME!!” shout from the doctor that will definitely keep you from making that mistake again. After the examination you have to go back to the bench, until you are at least 4-5 cm dilated (and you are lucky enough that someone examines you at that stage, otherwise you might be waiting even longer). For those who are not familiar with those terms, that is a whole lot of contractions later, and quite far in the whole labour process. At that stage you finally get a bed (if there is one available). Not a private bed, but a bed in a room with 5 other women, in a room that is smelly, hot, dirty, and in a desperate need of some renovation work. If you don’t walk fast enough towards the delivery room the midwife will very willingly push you in the right direction, or shout. But at least you can lie down now. Or actually, you have to lie down now: going outside a one-meter range of the bed is off-limits.

The husband is not allowed to come inside; he (or any other relative) has to wait downstairs in the hospital courtyard until the midwife shouts his name through the window. If he’s lucky it will be to tell him that he has a healthy baby girl or boy, but it can also be to go and quickly buy medicine or water for the woman in labour. No updates on what is happening at the women’s quarters whatsoever.

There is no help with ‘puffing’ away pain of contractions (there is of course also no such thing as antenatal couples pregnancy gym...), there is no explanation from the midwifes during the process. When the time is there the midwife tells you to push, the baby comes, is quickly shown with legs spread to show the sex to the mother and then taken away to be measured and weighed. As you can imagine there is not much of magical amazement at this point. There is mainly relief that this scary, painful, and lonely process is over. Women just lay there, sweaty, hot, and almost in apathy to their surroundings, until they are ordered to stand up again and walk (!) to another room where they can lay down a little while before they have to go somewhere else.

In this way an average of 30 deliveries per day happen at the hospital, which means in peak season (end of March – July) almost 50 a day. Fifty deliveries on a labour ward with only 13 beds (including 4 in the hallway), and a maximum of 4-6 midwifes on duty (with some times some extra students and if you’re lucky a doctor for the first examination). Since it is a referral hospital almost all of these women have or have had complications during pregnancy or delivery, which gives them an increased risk for a complicated delivery.

Altogether you can imagine that a day working at this labour ward can be quite intense. I especially have a very hard time with he way the women are communicated to (or actually the lack of communication towards the women). Orders are shouted, not so many nice words, no comforting. This is surely partly biased because of my different frame of reference, and the way English is used directly translated from Twi (which is a language without the fuss of polite forms, but just ‘you sit now’, ‘you go!, ‘walk to that place’). So with this in mind it just might sounds harsh to me, but the women might not experience it that way... Let’s hope so.

However, standing beside it all, in the difficult position of the intern at the bottom of the hierarchy, it made me feel so powerless! After the first day I did manage to use the time that the doctor was updating the patient record to introduce myself to the next woman in line and do some small talk with some nice words, but still it stayed frustrating. I can’t wait to work in this kind of setting and finally be able to do things how I would want to do them. Because yes, the workload is crazy and it will be very difficult to stay nice, but I really hope that I will be able to do so at least a little bit before examining a woman’s private parts (sorry for the explicitness...).

Even though you all might wonder at this point why I still would want to work in a setting like this, I actually have arranged that I will be going back to Ghana again at the end of May for another internship. This time it will be an actual clinical internship at the paediatrics department of the small district hospital way up north in Bawku (you can Google-map it to see that it is quite difficult to get much more Northern than that, on the border with Burkina Faso and Togo). Before coming to Ghana I bumped into a Dutch doctor that I knew from my internships in Holland at the embassy in The Hague. He was preparing his documents to start working in Ghana for a longer period of time, so we exchanged contact details. So after coming home in a bit more than 2 weeks, I’ll be leaving again for another 6 weeks at the end of May, but this time not in the urban setting, but in an area where I’m the only white person together with the other doctor... I will try to write updates during that period too. And after that I will stay in Holland for quite some time again. Promise...

For now only one more week of work, mainly at home to work on my data from the research (I got a bit stressed-out at the hospital when I thought about all the stuff I still need to do for my thesis...) and then Evelien is coming to visit for a final week of travelling up north! I couldn’t believe it when she spontaneously told me she wanted to book a flight, and then just did it within the next 48 hours! I just have the best friends!

Oh... and it’s time for another list of fun stuff, because besides working I also experienced some other fun things like:

... climbing the highest mountain in Ghana (not even 900 m high, but when I came to the top I looked like I walked through a fierce Dutch autumn shower... yes, sweaty business, blimey it was hot!!)
... hiking through beautiful butterfly-filled jungle to a quiet waterfall in the Volta Region (followed by a refreshing plunge of course, using the fact that we were the only one there... magical!)
... crossing shimmering Lake Volta by bridge in a tro-tro going back to Accra from the ‘mountains’
... realising that I really know my way around here by helping out some newly moved in roommates
... starting to talk Ghanaian English (‘oh, sorry-oh!’, ‘Ej! Why?’ [a response to anything that might surprise you or you think is not nice], ‘Oohwokay! [the response to anything. Any-thing!] ‘She’s not picking.’[she’s not answering her phone], ‘Flash me!’[please let my phone ring once so I have your number], ‘I’m coming’ [just wait a minute... or longer])
... not being surprised that all the babies here are actually born with very light skin, sometimes it makes you wonder whether the father is Caucasian, but he never is.
... having people recognise me at some places we go to regularly (the gym, our favourite restaurant after going to the gym, the women in our street)
... going through my phone contacts and not thinking it strange that it is full with: ‘Wisdom’, ‘Nice-one’, ‘Iron Man’, ‘Love’, 'Divine', and more...
... not being surprised anymore that a taxi driver happily tells me that he is married but available (or MBA for short).... Ghanaians really have a different view of monogamy!

See you all very soon! But probably I’ll write one more post before that.


Weighing infants at the postnatal clinic

Scaring away the evil eye with infant eye-liner :)

One of the midwifes, I just love the uniforms!

Waiting for antenatal care


That's what I call green!

Fresh jungle streams, I just love water!

Unfortunately a bit cloudy, but still a nice view from Afadjato Mountain

In the jungle, the mighty jungle...

Tagbo Fall... ain't it a beauty?

Karin and I at the Wli Falls


  1. WoW Geerte... Ik wist wel dat we hier gezegend zijn met de ruimte, middelen- begeleiding etc. tijdens de geboorte van een baby, maar wat je hierboven beschrijft.. wow. Ik heb zelfs een lijstje gemaakt bij de geboorte van Alisia, ( met dingen die ik absoluut niet of juist wel wilde) -als ik lees hoe dat daar gaat schaam ik me bijna. Wat een contrast!!! ( heb je blogentree voorgelezen aan lukas, hij was ook geschokt en zei; mega brutal hoe dat daar gaat,.. te bedenken dat een geboorte op zich al zo ' brutal' is!!! Kan me voorstellen dat t voor jou niet makkelijk is zo te moeten werken! Dankjewel voor je indrukwekkende verhaal!

    1. Het contrast is inderdaad heel groot... maar deels kan het ook haast niet anders. En ook is het deels gewoon een stuk cultuur. Vrouwen krijgen veel kinderen, het hoort erbij, het is gewoon niet zo een speciaal ding als in het Westen... maar aan de andere kant denk ik dat het toch ook wel anders kan. Er is veel chaos, veel inefficiëntie (efficiëntie is hier überhaupt geen begrip...), veel wat met een glimlach al fijner zou gaan. Zoals in bij ons kan het niet, gewoon door het gebrek aan alles, maar toch heb ik ook het gevoel dat het niet zo hoeft zoals het nu gaat. Tja... moeilijk, machteloos gevoel. Het allermoeilijkste is nog wel dat in theorie mensen het wel 'goed' doen! Je zou is moeten horen wat voor een praatjes/presentaties de artsen hier houden bij de ochtendoverdracht (elke week moet een arts in opleiding iets voorbereiden over een onderwerp). Echt volgens het boekje! Maar in praktijk... en het probleem is daarmee dus dat praten geen zin heeft! In woord is iedereen het met je eens, maar in daad wordt er compleet iets anders gedaan :) Liefs!