And Now For Something Completely Different

It’s nighttime in the Valley, a remote, rural part of China to which I’ve travelled from Kunming. As soon as the sun drops below the mountains, the clouds that had burned off during the day return, hastening the darkness.

Those of you who have read other parts of this blog may know that I am a birth doula and aspiring midwife, not a tech blogger. Since midwifery is an even more marginalized and beleaguered profession in China than in the US (and that’s saying something) it was through sheer luck that last year I happened to meet Barbara, an American midwife in Kunming, that she took me under her wing, and that we have been able to travel to this corner of China together. Barbara would call it providence.

We first came here several months ago, invited by the local hospital to conduct a series of trainings in midwifery skills that could help the staff deal non-surgically with the problems they most often see in birthing and postpartum women. The maternity ward of this hospital, a series of adjoined, muddy, concrete boxes, has at most 15 beds in its four rooms to serve a population of some 100,000 predominantly ethnic minority people. The hospital staff, of course, are mostly Han Chinese.

Occasionally the ward is very quiet, with one or two postpartum women lying silently, their new babies beside them bound up in blankets and string like pork roasts. But today was a full house – every bed containing a laboring woman or a new mother and her tiny child, the space in between the beds filled up with husbands and female relatives, small bundles of clothes, food that the families must bring themselves. Last night had been sleepless, a nurse told me, with four women giving birth before dawn. Women, like many mammals, birth more easily during the night, when quiet and darkness leave them less disturbed and more able to concentrate.

When we arrived on the ward this morning, we picked our way among the families and laboring women, searching for a nurse or doctor to recognize and welcome us – as foreigners who drop by only periodically, we are never sure what the reception from the staff will be, despite their having invited us to come. In my peripheral vision I saw a nurse dash from one room across the hall to another and spied a doctor filling syringes in an office at the end of the corridor, but no one looked familiar to me. Was it because all of the staff we had previously met were working a different shift, or because they had all left and been replaced? People change jobs so often and casually here that it was hard to know.

I peered into the staff lounge – really just a cramped patient room, with two beds, that the staff have commandeered – and saw the figure of the ward Matron standing in the window. The Matron is a saucy old broad, unflappable. A head shorter than I am, her face is perfectly round and beginning to be weathered by middle age. If you encounter her outside the hospital, she will be wearing acid washed, appliquéd jeans and a frilly top in the fashionable local manner, her pixie cut moussed into a small bouffant. In the hospital, she wears baby pink from head to toe – nurse’s cap; button-down, short-sleeved scrub dress falling to her knees; spongy, orthopedic shoes. She looks not unlike a waitress at a roadside diner.

Removing the cigarette hanging precariously from her bottom lip, and stubbing it into a wet sponge on the window sill, she called out to me by my Chinese name. “You’re back!” Her voice was croaky as always. “Where is Barbara? We’ll go see the patients.”

Barbara had already installed herself at a patient’s bedside, and was inspecting a slightly jaundiced newborn. The Matron approached her and they made exaggerated, noisy greetings in each others’ directions – the Matron speaks no English, and Barbara speaks no Mandarin. I’m the translator.

The three of us headed over to the far side of the small room to meet a postpartum woman who had been hospitalized for 10 days. She had arrived in labor, with her water broken and a severe infection setting in. She had first visited a village clinic half an hour away up a mountainside – when she had a seizure there, they had made her leave for the hospital. After another seizure at the hospital, she was taken for an emergency cesarean, during which they drained liters of fluid from her abdomen, later inserting catheters to continuously drain the fluid from her body, still accumulating mixed with blood as she lay in front of us.

I pride myself on being known for my toughness and I am embarrassed to admit that my biggest concern about entering nurse-midwifery school is that I will vomit or cry in front of a patient. The wound that a cesarean leaves is always barbaric looking at first – either sewn or stapled shut, I have yet to see a fresh incision that did not look to me like some form of torture. This woman’s wound was no different, regardless of the fact that the surgery had almost certainly saved her life and that of her baby.

Barbara and the Matron variously commented on how well the woman was doing – her infection was clearing, her incision healing, her fever had broken. But this woman was panting, subtly shaking, her face rigid; it seems that people here do not like to discuss their pain, and this woman was palsied with her attempts to hide it. I did not cry, but I wanted to. If someone could let me know why Chinese hospitals so rarely give medication for pain, I’d appreciate it.

We made our rounds of the other patients, all healthy if immobile, discouraged from leaving their beds. The laboring women lay on their sides, IVs tethering them to the wall. The new mothers drank chicken soup and ate hard-boiled eggs, their heads wrapped tightly in scarves to keep the “cold air” from getting to them, according to traditional Chinese medical practice.

We were finally taken to a room that previously I had seen used only for storage, but that was being used today to hold two patients. Dim and airless, the room stank of sickness. The entire maternity ward carries a foul smell, the stench of years of disinfectant fluid spreading dirt evenly across the floor mixed with the stale odor of clothes and bed linens too infrequently washed. The dogs that wander the halls and patient rooms don’t help. The hospital has no janitorial staff, so it is the responsibility of unenthusiastic doctors, nurses and patients’ families to clean the place. This room seemed to be the one that was cleaned least frequently, and I caught myself holding my breath.

What brought these women to the hospital, however, was not contagious. On one bed lay a woman about to give birth, and on the other a woman condemned to death by tumors. Shrunken and white-haired, her abdomen was distended with metastasized uterine cancer. Unable to eat or drink, she periodically spit up clear fluid and blood into the tissues held out by the attentive younger women of her family. Looking over one of their shoulders, I saw the woman’s face tighten and contort. I thought she was seized by pain, but I saw her lips move and understood then that she was praying.

13 thoughts on “And Now For Something Completely Different

  1. I’m really glad to have found your blog. I am a Newborn ICU nurse in the States and we just adopted our daughter from Kunming in June so I love the medical information combined with the China stuff. Very interesting. You almost make me want to go back to school to do midwifery. Almost.

    • I honestly don’t know. I think there’s much more an attitude of “grin and bear it” here. Obviously, if you have to have surgery they anesthetize you (to an appropriate degree, mostly…), but if it’s something that they would consider a small procedure (like stitching up an episiotomy!) they don’t.

    • Very interesting site, msasch!

      Please have your wife get in touch with me (birdabroadblog AT gmail DOT com) – I’d love to hear what she’s up to.

    • Thanks for your comment, Rich. What I was talking about here was not so much relieving the pain of labor, but relieving the pain of major abdominal surgery – for which I think pulling out the big time drugs is warranted.

      You’re absolutely right that hypnosis can be helpful for relieving/preventing labor pain, for some women in some circumstances. Unfortunately the concept of hypnosis is not an accepted one among ethnic minority people here, and I don’t think that hypnosis is something that can be effectively foisted on people without their active participation. Also, I can only speak Mandarin, not the local language here – and the local women often have very little Mandarin. Were I to be here long term I would certainly learn the local language, but since I’m here for such a short time it’s not really feasible to learn much…

  2. Hi!
    My husband and I are Canadian and moved to Kunming a couple of months ago. I am a midwifery student with Mercy in Action in the Philippines doing distance ed with them right now (I did a month clinical in June). I can’t tell you how excited I am to find a midwifery connection here in Kunming… This may be very forward but I would love to know how to get involved… even if it is just talking with you and others you work with…
    Kelley Chong

    • Hi Kelley! Great to hear that you are in Kunming and are studying midwifery. Unfortunately, I’ve left China so we can’t meet up face to face, but do get in touch by email at birdabroadblog AT gmail DOT com. I’d be happy to pass on whatever information I have that would be helpful to you!

  3. You write beautifully about your experiences in China. Only wish I’d stumbled upon your blog while living in Beijing – I had some pretty severe culture shock. And good luck on your doula path, I’m a big believer as I did a Calm Birth course with a fantastic doula in Hong Kong who helped me have an amazing birth. Reading this and other of your posts on birthing makes me all the more grateful.

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