I’ve parked myself with a can of beer in front of my room’s electric fan, vainly hoping that either will do something to cut through the humidity that has settled into the Valley over the past few days. Barbara and I just came back from dinner at the house of a foreign friend who lives near by; after dinner we sat with the lights off in the living room, eating a mountain of lychees to keep cool. I complimented her on her beautiful Peruvian wall tapestries, and was then distracted by the concept of a place as inconceivably distant from the Valley as Peru – it might as well be a fairy tale. I spent the rest of the evening staring out the window of her home, overlooking the skeleton of a small, ruined power station in which villagers now grow corn in tight rows.
Tomorrow morning we meet with two local women to prepare a training for village women on life-saving skills relating to pregnancy, the postpartum period, and newborn health. One of the women only speaks the local language – let’s call it Azu – and the other speaks Azu and Mandarin. I’ll translate from Mandarin to English for Barbara, and the whole thing will be a little round-robin of translation and take three times as long as it should, but as we say in Mandarin: mei banfa.
One of the ways I know that my Mandarin skills have improved since we moved to China is that the prospect of this kind of activity only makes me a little nervous, as opposed to paralyzingly nervous in a manner that requires closed eyes and deep breathing. Now I always do pretty well in these situations, if I do say so myself. It’s tomorrow afternoon’s plan, returning to the hospital, that’s got me a little worried.
Back at the Hospital
On Friday we stopped by to see the Matron, and when she wasn’t in that day we casually made rounds, mostly to check on the woman who had had the emergency cesarean and severe infection. She seemed to have improved somewhat from the day before, but as we stood by her bedside I looked at the woman lying in the bed next to her – and then I looked again.
I recognized the face peeking out from underneath heavy blankets, her eyes just showing beneath her “new mother’s” head scarf. When we had visited the day before, she had just arrived at the hospital in labor, with her water already broken. She didn’t seem to be in heavy labor yet, and when Barbara examined her she noted that the baby was posterior, its head wasn’t engaged in the pelvis, and there was very little amniotic fluid remaining. A posterior baby (“sunnyside up”) is often more painful to deliver, but will usually come out on its own with a little maneuvering. One whose head isn’t sufficiently engaged in the pelvis might not come out at all, necessitating a c-section.
There are ways to encourage the baby to move down, but the hospital doesn’t favor any of them. They don’t like the women to move around in general, and particularly not after the water has broken because they fear cord prolapse (that the cord will slip out before the baby, which can be fatal as it cuts off the baby’s oxygen supply). This is not a well-founded fear when there is very little amniotic fluid, so Barbara encouraged this woman to walk the hospital corridor and to stay well hydrated.
The whole thing was hopeless. Let me explain the issues.
The Problems of Hospital Birth for Azu Women
1) This woman had been hooked up to an IV of oxytocin, to make her contractions stronger – this IV bag hangs from a runner attached to the ceiling. It is not mobile. So if she wants to walk the halls (which the staff do not want her to do anyway), they have to unhook the IV from the ceiling and someone in her family has to trail around behind her, holding the bag over their head. This gets tiring, so they do it for 5 minutes, drop their arm, and then the staff tell her to get back in bed.
2) The woman was thirsty, but refused to drink water. She refused to drink not because she’s a fool, but because the maternity ward has no bathroom – so if she wants to use a bathroom she has to go at least downstairs to another ward, or to an outhouse outside the hospital, which is not all that appealing when you’re in labor. The maternity ward does encourage women to use bedpans, but they had run out of bedpans by the time this particular woman arrived. Even if they had given her one, the women don’t tend to use them because they are in open wards, with no curtains separating the beds, so they would have to use them in front of other women’s husbands and relatives. Not gonna happen if they can help it – so they drink as little as possible.
3) By the time this woman arrived, her water had already been broken for two days. She had waited so long to come in for numerous reasons, including: a) Azu women tend to minimize their pregnancies and labors as long as possible. There are taboos surrounding pregnancy and birth that mean such things are rarely spoken of; b) Many Azu women, including this one, live a tremendous distance from the two-street town center where the hospital is located – they don’t want to walk hours and hours down a mountain if they’re not sure whether or not they’re really in labor; and c) Azu women don’t really like the hospital. The care is free, and they’re even given a cash incentive to show up and give birth there, but they still often prefer to stay in their villages. The local government has made that a moot point by recently passing a law requiring them to come to the hospital, but many are still unhappy about it; they have a hard time communicating with the Chinese staff, many of whom don’t speak Azu at all. They feel looked down upon and condescended to by these more affluent “city folk”, who look different, speak differently, dress differently.
4) And then there are all of the larger reasons that any Azu woman here is disadvantaged giving birth; their diets tend to consist of only a few vitamin-poor staple foods at any given time (potatoes, cabbage, hominy). They generally receive no prenatal care, meaning that any problems tend to become emergencies, usually at the time of birth.
This particular woman finally received a cesarean several hours before we arrived at the hospital. In light of the other woman with the severe infection, seizures and emergency cesarean, the hospital staff had gotten too nervous to wait any longer – her labor had stopped, they told me.
And now here she was, under blankets, her baby in some distant part of the hospital. She was mumbling, delirious with pain, unable to open her eyes. I knelt down beside her and squeezed her hand – what else is there to do? – and tears began to stream from her eyes, forming a little reservoir where they reached her nose. She squeezed my hand back and began to sob and shake – I worried that I was making it worse.
I noticed a young man and an old couple nervously hovering against one wall of the room and asked if they were her family – yes, they said. Because the hospital has no chairs or stools for anyone to sit on, they didn’t know where to be. I managed to scrounge a stool from a closet so that her husband could sit next to her, so that at least she would know he was there. When I walked past the room later on, I saw him spooning soup into her mouth.
We’ll see if she’s doing any better tomorrow.
Shabbes in the Valley
I did not grow up an observant Jew, but I’ve been experimenting with a few things lately, trying them on to see how they fit. Last month I decided to start lighting candles on Friday nights, for Shabbes – I cover my head, I light the handles, I wave the flames toward me and cover my eyes, I say the prayers. When I’m done feeling like I’m playing dress up, the whole thing feels pretty good. The first prayer I should say, of course, is to Adonai, Eloheinu, creator of the fruits of the internet – because seriously, I wouldn’t know how to do any of this stuff otherwise.
Shabbes is always supposed to be a welcome event in the week, but after Friday at the hospital it seemed particularly necessary to light the candles, to go through the steps, to create a break with what had happened before.
I hadn’t brought anything to the Valley with which to cover my head, so I went out and bought the first head scarf I could find, which is one traditionally worn by older Azu women. Barbara was suitably impressed, so she took this photo of me (in which I realize that the shirt-scarf combination is sort of a horrifying optical illusion of plaid – apologies).
On Saturday night, I lit an improvised Havdalah candle for the first time in my life, accompanied not by wine but by Coke Zero, which, unlike wine, is available all over the Valley. I liked Havdalah – maybe this coming week I’ll even spring for some fruit juice.